Provider Demographics
NPI:1114094596
Name:CHOE, I CHOL (OD)
Entity Type:Individual
Prefix:MR
First Name:I
Middle Name:CHOL
Last Name:CHOE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:DERRICK
Other - Middle Name:I
Other - Last Name:CHOE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:8862 161ST AVE NE
Mailing Address - Street 2:#105
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052
Mailing Address - Country:US
Mailing Address - Phone:425-881-6655
Mailing Address - Fax:425-671-0848
Practice Address - Street 1:8862 161ST AVE NE
Practice Address - Street 2:#105
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052
Practice Address - Country:US
Practice Address - Phone:425-881-6655
Practice Address - Fax:425-671-0848
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAWA3404152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2024024Medicaid
WAAB10501Medicare ID - Type Unspecified
U75947Medicare UPIN