Provider Demographics
NPI:1114977261
Name:CHOI-CHUNG, SUSAN SEONSHIL (OD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:SEONSHIL
Last Name:CHOI-CHUNG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:SUSAN
Other - Middle Name:S
Other - Last Name:CHOI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:500 HEMPSTEAD TPKE
Mailing Address - Street 2:DBA: COHENS FASHION OPTICAL
Mailing Address - City:WEST HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11552-1125
Mailing Address - Country:US
Mailing Address - Phone:516-489-2262
Mailing Address - Fax:516-539-0296
Practice Address - Street 1:500 HEMPSTEAD TPKE
Practice Address - Street 2:DBA: COHENS FASHION OPTICAL
Practice Address - City:WEST HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11552-1125
Practice Address - Country:US
Practice Address - Phone:516-489-2262
Practice Address - Fax:516-539-0296
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2013-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000325152W00000X
NYTUV007102-1152W00000X
TX5717TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1367639OtherCLARITY VISION
NYNY7102OtherEYEMED
PA160871OtherCOLE MANAGED VISION
NY03478993Medicaid
PA397400OtherNATIONAL VISION ADM
PA397400OtherNATIONAL VISION ADM
V08170Medicare UPIN