Provider Demographics
NPI:1326322645
Name:NG, LILY (OD)
Entity Type:Individual
Prefix:
First Name:LILY
Middle Name:
Last Name:NG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:758 TREMONT ST
Mailing Address - Street 2:APT 1
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-1105
Mailing Address - Country:US
Mailing Address - Phone:781-985-0398
Mailing Address - Fax:
Practice Address - Street 1:250 GRANITE ST
Practice Address - Street 2:SEARS OPTICAL
Practice Address - City:BRAINTREE
Practice Address - State:MA
Practice Address - Zip Code:02184-2804
Practice Address - Country:US
Practice Address - Phone:781-843-4295
Practice Address - Fax:781-848-4868
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-05
Last Update Date:2014-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4866152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist