1184624082 NPI number — JASON R CHIN OD

Table of content: JASON R CHIN OD (NPI 1184624082)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184624082 NPI number — JASON R CHIN OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHIN
Provider First Name:
JASON
Provider Middle Name:
R
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
OD
Provider Gender Code:
M

Provider's Other Name Information

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 Information

NPI Number:
1184624082
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/05/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
930 COMMONWEALTH AVE
Provider Second Line Business Mailing Address:
SUITE 2 NEW ENGLAND EYE INSTITUTE
Provider Business Mailing Address City Name:
BOSTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02215
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-587-5511
Provider Business Mailing Address Fax Number:
617-236-6323

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
930 COMMONWEALTH AVE
Provider Second Line Business Practice Location Address:
SUITE 2A NEW ENGLAND EYE COMMONWEALTH
Provider Business Practice Location Address City Name:
BOSTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02215
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-262-2020
Provider Business Practice Location Address Fax Number:
617-236-6323
Provider Enumeration Date:
07/21/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  4411 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000000037211 . This is a "BMC HEALTHNET" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0701441 . This is a "MASS HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 701441 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5594616 . This is a "FIRST HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: W17559 . This is a "MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: AA26386 . This is a "HARVARD PILGRIM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 495654 . This is a "TUFTS" identifier . This identifiers is of the category "OTHER".
  • Identifier: W16412 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 35226 . This is a "NHP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3796048 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9695610 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: MA4411 . This is a "EYEMED" identifier . This identifiers is of the category "OTHER".




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