Provider Demographics
NPI:1407367923
Name:CHO, JUSTINA (OD)
Entity Type:Individual
Prefix:
First Name:JUSTINA
Middle Name:
Last Name:CHO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2272 HENDY LN
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95124-4415
Mailing Address - Country:US
Mailing Address - Phone:808-391-6757
Mailing Address - Fax:
Practice Address - Street 1:2272 HENDY LN
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124-4415
Practice Address - Country:US
Practice Address - Phone:808-391-6757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-24
Last Update Date:2017-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33847TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist