Basic Information
| Provider Information | |||||||||
| NPI: | 1215191077 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MAGNO-CHOI | ||||||||
| FirstName: | JACLYNNE | ||||||||
| MiddleName: | Y. | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | O.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | CHOI | ||||||||
| OtherFirstName: | JACLYNNE | ||||||||
| OtherMiddleName: | Y. | ||||||||
| OtherNamePrefix: | MRS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 11611 CHADWICK RD | ||||||||
| Address2: | |||||||||
| City: | CORONA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928809450 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7147470741 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 13310 TELEGRAPH RD | ||||||||
| Address2: | |||||||||
| City: | SANTA FE SPRINGS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 906704016 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5629031618 | ||||||||
| FaxNumber: | 5629468068 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2008 | ||||||||
| LastUpdateDate: | 10/18/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 13532TLG | CA | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.