=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437352812
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHOI EYE INSTITUTE, P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/06/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1107 MEMORIAL DR SUITE 102
-----------------------------------------------------
City | DALTON
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30720-8662
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-529-8733
-----------------------------------------------------
Fax | 706-275-0354
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1107 MEMORIAL DR SUITE 102
-----------------------------------------------------
City | DALTON
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30720-8662
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-529-8733
-----------------------------------------------------
Fax | 706-275-0354
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. YOUNG HWAN CHOI
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 423-544-7236
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 156FX1100X
-----------------------------------------------------
Taxonomy Name | Ophthalmic Technician/Technologist
-----------------------------------------------------
License Number | 056275
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------