Provider Demographics
NPI:1215191077
Name:MAGNO-CHOI, JACLYNNE Y (OD)
Entity Type:Individual
Prefix:MRS
First Name:JACLYNNE
Middle Name:Y
Last Name:MAGNO-CHOI
Suffix:
Gender:F
Credentials:OD
Other - Prefix:MRS
Other - First Name:JACLYNNE
Other - Middle Name:Y
Other - Last Name:CHOI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11611 CHADWICK RD
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92880-9450
Mailing Address - Country:US
Mailing Address - Phone:714-747-0741
Mailing Address - Fax:
Practice Address - Street 1:13310 TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:SANTA FE SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:90670-4016
Practice Address - Country:US
Practice Address - Phone:562-903-1618
Practice Address - Fax:562-946-8068
Is Sole Proprietor?:No
Enumeration Date:2008-07-10
Last Update Date:2018-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13532TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist