Healthcare Provider Details

I. General information

NPI: 1972768075
Provider Name (Legal Business Name): KIT TUNG IP OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2008
Last Update Date: 05/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 STANIFORD ST SUITE 600
BOSTON MA
02114-2517
US

IV. Provider business mailing address

1125 COMMONWEALTH AVE APT 19
ALLSTON MA
02134-3201
US

V. Phone/Fax

Practice location:
  • Phone: 617-367-4800
  • Fax: 617-723-7028
Mailing address:
  • Phone: 617-447-7523
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4687
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: