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NPI Code Detail

MEDICARE: DR. SUSAN CHOE O.D.

MEDICARE: DR. SUSAN CHOE O.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometrist33641CA

General Provider Information

NPI Number : 1306370093
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SUSAN CHOE O.D.
Provider Business Mailing Address
First Line : 96 ALFRED CT
Second Line :
City : VERNON HILLS
State : IL
Zip : 60061-3250
Country : US
Telephone Number : 847-338-9379
Fax Number :
Provider Business Practice Location Address
First Line : 1760 S PACIFIC COAST HWY
Second Line :
City : REDONDO BEACH
State : CA
Zip : 90277-5902
Country : US
Telephone Number : 310-540-2970
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/19/2017
Last Update Date : 04/19/2017

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