Provider Demographics
NPI:1851443493
Name:KORB, DONALD ROY (OD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:ROY
Last Name:KORB
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:400 COMMONWEALTH AVENUE
Mailing Address - Street 2:UNIT 2
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215
Mailing Address - Country:US
Mailing Address - Phone:617-426-0370
Mailing Address - Fax:617-426-4924
Practice Address - Street 1:400 COMMONWEALTH AVE
Practice Address - Street 2:UNIT 2
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215
Practice Address - Country:US
Practice Address - Phone:617-426-0370
Practice Address - Fax:617-426-4924
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2019152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
150817OtherHARVARD PILGRIM HEALTHCAR
2019OtherVISION BENEFITS OF AMERIC
2200579OtherUNITED HEALTHCARE
2203336OtherAETNA HEALTHCARE
MAW15419OtherBCBS MA
042304182OtherVISION SERVICE PLAN
MA0308714Medicaid
39436000OtherDAVIS VISION EYECARE
MA712889OtherTUFTS HEALTH PLAN
042304182OtherVISION SERVICE PLAN
MA0308714Medicaid