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General NPI Number Information
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NPI Number | 1235688557
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Entity Type | Organization
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Legal Business Name | CAMBRIDGE EYE GROUP INC
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Dates
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Enumeration Date | 09/27/2016
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Last Update Date | 09/27/2016
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Provider Practice Location Address
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Address Line | 603 CONCORD AVE SUITE B
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City | CAMBRIDGE
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State | MA
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Zip | 02138-1197
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Country | US
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Telephone | 617-818-0476
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Fax |
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Provider Business Mailing Address
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Address Line | 169 MONSIGNOR OBRIEN HWY 415
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City | CAMBRIDGE
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State | MA
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Zip | 02141-1289
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JACKY KONG
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Credential |
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Telephone | 617-818-0476
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152WC0802X
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Taxonomy Name | Corneal and Contact Management Optometrist
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License Number | 4687
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 152WP0200X
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Taxonomy Name | Pediatric Optometrist
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License Number | 4689
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License Number State | MA
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Taxonomy #3
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Taxonomy Code | 152WS0006X
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Taxonomy Name | Sports Vision Optometrist
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License Number | 4689
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License Number State | MA
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Taxonomy #4
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Taxonomy Code | 152WV0400X
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Taxonomy Name | Vision Therapy Optometrist
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License Number | 4689
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License Number State | MA
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Taxonomy #5
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 4689
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License Number State | MA
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