Provider Demographics
NPI:1710674221
Name:CAMBRIDGE EYE GROUP INC
Entity Type:Organization
Organization Name:CAMBRIDGE EYE GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JACKY
Authorized Official - Middle Name:KIN WAI
Authorized Official - Last Name:KONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-818-0476
Mailing Address - Street 1:169 MONSIGNOR OBRIEN HWY APT 415
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02141-1262
Mailing Address - Country:US
Mailing Address - Phone:617-818-0476
Mailing Address - Fax:
Practice Address - Street 1:354 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:MA
Practice Address - Zip Code:02478-3246
Practice Address - Country:US
Practice Address - Phone:617-818-0476
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAMBRIDGE EYE GROUP INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-04-24
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center