Provider Demographics
NPI:1801106968
Name:SANTA CLARA OPHTHALMOLOGY INCORPORATED
Entity type:Organization
Organization Name:SANTA CLARA OPHTHALMOLOGY INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HO SUN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHOI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:408-777-6350
Mailing Address - Street 1:2081 FOREST AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-4841
Mailing Address - Country:US
Mailing Address - Phone:408-777-6350
Mailing Address - Fax:408-777-6354
Practice Address - Street 1:2081 FOREST AVE STE 2
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-4841
Practice Address - Country:US
Practice Address - Phone:408-777-6350
Practice Address - Fax:408-777-6354
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-07
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA112440207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADR547AOtherMEDICARE PTAN
CADR547AMedicare PIN