=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710833785
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHESTNUT HILL VISIONCARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/10/2026
-----------------------------------------------------
Last Update Date | 03/10/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 199 BOYLSTON ST
-----------------------------------------------------
City | CHESTNUT HILL
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02467-1692
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-971-8817
-----------------------------------------------------
Fax | 617-969-1770
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 210 PALFREY ST
-----------------------------------------------------
City | WATERTOWN
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02472-1836
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-688-6157
-----------------------------------------------------
Fax | 617-969-1770
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OPTOMETRIST
-----------------------------------------------------
Name | DR. HANIEH YAGHOOBI
-----------------------------------------------------
Credential | OD
-----------------------------------------------------
Telephone | 505-688-6157
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------