1194760389 NPI number — MATTHEW J KAIM O.D.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194760389 NPI number — MATTHEW J KAIM O.D.

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

KAIM

Provider First Name:

MATTHEW

Provider Middle Name:

J

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

O.D.

Provider Gender Code:

M

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1194760389

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

10/13/2009

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

50 JEFFERSON ST

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

WINTHROP

Provider Business Mailing Address State Name:

MA

Provider Business Mailing Address Postal Code:

02152-2649

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

617-846-1734

Provider Business Mailing Address Fax Number:

617-846-3292

Provider First Line Business Practice Location Address:

50 JEFFERSON ST

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

WINTHROP

Provider Business Practice Location Address State Name:

MA

Provider Business Practice Location Address Postal Code:

02152-2649

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

617-846-1734

Provider Business Practice Location Address Fax Number:

617-846-3292

Provider Enumeration Date:

06/19/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 152W00000X , with the licence number:  3084 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 0011850 . This is a "NEIGHBORHEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
• Identifier: W20357 . This is a "BLUE CROSS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
• Identifier: 114365 . This is a "EYE MED" identifier . This identifiers is of the category "OTHER".
• Identifier: 2517744 . This is a "AETNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
• Identifier: 0392103 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
• Identifier: 732780 . This is a "TUFTS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
• Identifier: W15952 . This is a "BLUE CROSS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
• Identifier: 14354 . This is a "SPECTERA" identifier . This identifiers is of the category "OTHER".
• Identifier: 7582 . This is a "DAVIS VISION" identifier . This identifiers is of the category "OTHER".
• Identifier: AA10590 . This is a "HARVARD PILGRIM" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
• Identifier: MA3084 . This is a "VISION BENEFITS OF AMERIC" identifier . This identifiers is of the category "OTHER".
• Identifier: 22+00522 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".