Provider Demographics
NPI:1578995866
Name:CHIA, LIN MA (OD)
Entity Type:Individual
Prefix:DR
First Name:LIN
Middle Name:MA
Last Name:CHIA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:LIN
Other - Middle Name:
Other - Last Name:MA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:400 5TH AVE
Mailing Address - Street 2:SUITE 510
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02451-8706
Mailing Address - Country:US
Mailing Address - Phone:781-890-9922
Mailing Address - Fax:781-890-9944
Practice Address - Street 1:400 5TH AVE
Practice Address - Street 2:SUITE 510
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02451-8706
Practice Address - Country:US
Practice Address - Phone:781-890-9922
Practice Address - Fax:781-890-9944
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-08
Last Update Date:2015-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4962152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA4962OtherSTATE LICENSE