Provider Demographics
NPI:1215512629
Name:CHOQUETTE, NATHAN KENJI (OD)
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:KENJI
Last Name:CHOQUETTE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1098 NE ROMANE PL APT 5101
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97006-6072
Mailing Address - Country:US
Mailing Address - Phone:808-927-4696
Mailing Address - Fax:
Practice Address - Street 1:7421 SW BRIDGEPORT RD STE 200
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97224-7707
Practice Address - Country:US
Practice Address - Phone:503-598-7616
Practice Address - Fax:503-598-7617
Is Sole Proprietor?:No
Enumeration Date:2021-03-17
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORATI4564152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist