Provider Demographics
NPI:1063051092
Name:CHOI, CHARLEEN
Entity type:Individual
Prefix:DR
First Name:CHARLEEN
Middle Name:
Last Name:CHOI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4691 STATE HIGHWAY 121
Mailing Address - Street 2:
Mailing Address - City:THE COLONY
Mailing Address - State:TX
Mailing Address - Zip Code:75056-4010
Mailing Address - Country:US
Mailing Address - Phone:469-980-1365
Mailing Address - Fax:469-200-5332
Practice Address - Street 1:4691 STATE HIGHWAY 121
Practice Address - Street 2:
Practice Address - City:THE COLONY
Practice Address - State:TX
Practice Address - Zip Code:75056-4010
Practice Address - Country:US
Practice Address - Phone:213-798-2779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-20
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10146T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty