Provider Demographics
NPI:1417974114
Name:CHOE, JOO E (OD)
Entity Type:Individual
Prefix:
First Name:JOO
Middle Name:E
Last Name:CHOE
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 1:8725 MERION DR
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097-6661
Mailing Address - Country:US
Mailing Address - Phone:843-610-2020
Mailing Address - Fax:
Practice Address - Street 1:2100 PLEASANT HILL RD
Practice Address - Street 2:SUITE 259
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-4701
Practice Address - Country:US
Practice Address - Phone:843-610-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1355152W00000X
NC1748152W00000X
GAOPT0002532152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCD13557Medicaid
SCU837468582Medicare PIN
SCU83746Medicare UPIN