MEDICARE: GRACE CHOI 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	OPT 12396	CA

General Provider Information

NPI Number	:	1972596708
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRACE CHOI O.D

Provider Business Mailing Address
First Line	:	401 S BURNSIDE AVE
Second Line	:	#1L
City	:	LOS ANGELES
State	:	CA
Zip	:	90036-5372
Country	:	US
Telephone Number	:	323-931-3636
Fax Number	:

Provider Business Practice Location Address
First Line	:	6041 CADILLAC AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90034-1702
Country	:	US
Telephone Number	:	323-857-2673
Fax Number	:

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

Provider Enumeration Date	:	08/26/2005
Last Update Date	:	11/30/2021

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