Healthcare Provider Details

I. General information

NPI: 1396609376
Provider Name (Legal Business Name): LAWRENCE CHOI ABO OPTICIANA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2025
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21320 SW LANGER FARMS PKWY
SHERWOOD OR
97140-9105
US

IV. Provider business mailing address

21320 SW LANGER FARMS PKWY
SHERWOOD OR
97140-9105
US

V. Phone/Fax

Practice location:
  • Phone: 503-825-4055
  • Fax: 503-625-0549
Mailing address:
  • Phone: 503-825-4055
  • Fax: 503-625-0549

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number260897
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: