1578995866 NPI number — DR. LIN MA CHIA O.D.

Table of content: DR. LIN MA CHIA O.D. (NPI 1578995866)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578995866 NPI number — DR. LIN MA CHIA O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHIA
Provider First Name:
LIN
Provider Middle Name:
MA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MA
Provider Other First Name:
LIN
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
O.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1578995866
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/06/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
400 5TH AVE
Provider Second Line Business Mailing Address:
SUITE 510
Provider Business Mailing Address City Name:
WALTHAM
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02451-8706
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-890-9922
Provider Business Mailing Address Fax Number:
781-890-9944

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
400 5TH AVE
Provider Second Line Business Practice Location Address:
SUITE 510
Provider Business Practice Location Address City Name:
WALTHAM
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02451-8706
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-890-9922
Provider Business Practice Location Address Fax Number:
781-890-9944
Provider Enumeration Date:
08/08/2013

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:  4962 , 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: 4962 . This is a "STATE LICENSE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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