Provider Demographics
NPI:1720552599
Name:DR. CONNIE CHOI FAMILY OPTOMETRY
Entity Type:Organization
Organization Name:DR. CONNIE CHOI FAMILY OPTOMETRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:SHINAE
Authorized Official - Last Name:CHOI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:510-441-7403
Mailing Address - Street 1:30600 DYER ST
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94587-1717
Mailing Address - Country:US
Mailing Address - Phone:510-441-7403
Mailing Address - Fax:510-324-8591
Practice Address - Street 1:30600 DYER ST
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:CA
Practice Address - Zip Code:94587-1717
Practice Address - Country:US
Practice Address - Phone:510-441-7403
Practice Address - Fax:510-324-8591
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-15
Last Update Date:2019-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WV0400XEye and Vision Services ProvidersOptometristVision TherapyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA12903TPAOtherOPTOMETRY LICENSE
1104977693OtherNATIONAL PROVIDER IDENTIFICATION NUMBER