MEDICARE: DR. KWON JUNG 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
1	152W00000X	Optometrist	OPT003160	GA
2	152W00000X	Optometrist	0618001292	VA

General Provider Information

NPI Number	:	1548344914
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KWON JUNG CHOE O.D.

Provider Business Mailing Address
First Line	:	6961 TANGLEWOOD DR
Second Line	:
City	:	WARRENTON
State	:	VA
Zip	:	20187-8908
Country	:	US
Telephone Number	:	703-468-1389
Fax Number	:

Provider Business Practice Location Address
First Line	:	2539 JOHN MILTON DR
Second Line	:
City	:	HERNDON
State	:	VA
Zip	:	20171-2527
Country	:	US
Telephone Number	:	703-860-0600
Fax Number	:	703-870-7894

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/24/2006
Last Update Date	:	08/13/2020

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