Healthcare Provider Details

I. General information

NPI: 1619371572
Provider Name (Legal Business Name): LIXIN ZHENG
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2014
Last Update Date: 11/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

466 TRAPELO RD A
BELMONT MA
02478-1421
US

IV. Provider business mailing address

466 TRAPELO RD A
BELMONT MA
02478-1421
US

V. Phone/Fax

Practice location:
  • Phone: 617-489-3790
  • Fax: 617-489-1860
Mailing address:
  • Phone: 617-489-3790
  • Fax: 617-489-1860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4978
License Number StateMA

VIII. Authorized Official

Name: DR. LIXIN ZHENG
Title or Position: OWNER
Credential: O.D.
Phone: 617-489-3790