Healthcare Provider Details

I. General information

NPI: 1518586759
Provider Name (Legal Business Name): JONATHAN BEAUX LIN MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2020
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 HUNTINGTON AVE
BOSTON MA
02115-6303
US

IV. Provider business mailing address

243 CHARLES ST
BOSTON MA
02114-3002
US

V. Phone/Fax

Practice location:
  • Phone: 617-936-6100
  • Fax:
Mailing address:
  • Phone: 617-523-7900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number1028286
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: