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General NPI Number Information
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NPI Number | 1437905783
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Entity Type | Individual
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Provider Name | KRISTINE B LY
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Gender | Female
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Dates
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Enumeration Date | 04/27/2024
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Last Update Date | 02/15/2026
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Provider Practice Location Address
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Address Line | 260 TREMONT ST
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City | BOSTON
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State | MA
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Zip | 02116-5603
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Country | US
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Telephone | 617-636-4600
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Fax |
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Provider Business Mailing Address
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Address Line | 99 KNEELAND ST APT 908
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City | BOSTON
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State | MA
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Zip | 02111-2440
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Country | US
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Telephone | 702-576-1695
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPT8254
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License Number State | MA
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