Provider Demographics
NPI:1821541525
Name:CHOI, MICHELE (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:
Last Name:CHOI
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 1:7913 NANNESTAD ST
Mailing Address - Street 2:
Mailing Address - City:ROSEMEAD
Mailing Address - State:CA
Mailing Address - Zip Code:91770-3945
Mailing Address - Country:US
Mailing Address - Phone:626-592-7386
Mailing Address - Fax:
Practice Address - Street 1:601 W ARROW HWY
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91740-5411
Practice Address - Country:US
Practice Address - Phone:626-914-2414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-28
Last Update Date:2016-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT33436-TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist