Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician |
NPI | 1184893091 |
---|---|
Provider Name | Mrs. Jane C Choi |
First Address | Niles, IL 60714-3207 |
Second Address | Niles, IL 60714-3207 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/02/2008 |
Last Update Date | 04/11/2008 |