MEDICARE: CHOICE OPTICAL, INC

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	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1881217529
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHOICE OPTICAL, INC

Provider Business Mailing Address
First Line	:	2880 W OLYMPIC BLVD STE 101
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90006-2644
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2880 W OLYMPIC BLVD STE 101
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90006-2644
Country	:	US
Telephone Number	:	213-385-3388
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	BOKYUNG CHAE
Credential	:
Telephone Number	:	626-590-8660

Provider Enumeration Date	:	05/28/2020
Last Update Date	:	06/04/2020

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Directions to “CHOICE OPTICAL, INC ” Practice Location

Language	Start Address	Practice Location

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