| NPI | 1235688557 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACKY KONG President 617-818-0476 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MA 4689) |
| Additional Taxonomies | 152WC0802X Optometrist Corneal and Contact Management (Licence: MA 4687) |
| 152WP0200X Optometrist Pediatrics (Licence: MA 4689) | |
| 152WS0006X Optometrist Sports Vision (Licence: MA 4689) | |
| 152WV0400X Optometrist Vision Therapy (Licence: MA 4689) | |
| Enumeration Date | 2016-09-27 |
| Last Update Date | 2016-09-27 |