Provider Demographics
NPI:1497752539
Name:CHIN, TERRY L (OD)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:L
Last Name:CHIN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:886 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02111-1418
Mailing Address - Country:US
Mailing Address - Phone:161-742-3907
Mailing Address - Fax:161-742-3907
Practice Address - Street 1:886 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02111-1418
Practice Address - Country:US
Practice Address - Phone:161-742-3907
Practice Address - Fax:161-742-3907
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-05
Last Update Date:2010-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2610152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0330701Medicaid
MA163658Medicare ID - Type Unspecified