Provider Demographics
NPI:1053397604
Name:CHO, BRIAN YOUNG (OD, MS, FAAO)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:YOUNG
Last Name:CHO
Suffix:
Gender:M
Credentials:OD, MS, FAAO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 OLD PALISADE RD
Mailing Address - Street 2:#1902
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-7064
Mailing Address - Country:US
Mailing Address - Phone:212-938-4109
Mailing Address - Fax:
Practice Address - Street 1:5 BELLPORT LN
Practice Address - Street 2:
Practice Address - City:BELLPORT
Practice Address - State:NY
Practice Address - Zip Code:11713-2748
Practice Address - Country:US
Practice Address - Phone:631-286-4014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2018-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00600000152W00000X
NYTUV006837-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist