Basic Information
| Provider Information | |||||||||
| NPI: | 1982170841 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | JACLYNNE Y. MAGNO-CHOI, O.D. INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11611 CHADWICK RD | ||||||||
| Address2: | |||||||||
| City: | CORONA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928809450 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5629031618 | ||||||||
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| Practice Location | |||||||||
| Address1: | 13310 TELEGRAPH RD | ||||||||
| Address2: | |||||||||
| City: | SANTA FE SPRINGS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 906704016 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5629031618 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/18/2018 | ||||||||
| LastUpdateDate: | 10/18/2018 | ||||||||
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| AuthorizedOfficialLastName: | MAGNO-CHOI | ||||||||
| AuthorizedOfficialFirstName: | JACLYNNE | ||||||||
| AuthorizedOfficialMiddleName: | Y | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5629031618 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | OD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
No ID Information.