Provider Demographics
NPI:1891877825
Name:RONG, BING LAN (OD)
Entity Type:Individual
Prefix:DR
First Name:BING LAN
Middle Name:
Last Name:RONG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 MIDDLESEX TPKE
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01803-4914
Mailing Address - Country:US
Mailing Address - Phone:781-270-7800
Mailing Address - Fax:
Practice Address - Street 1:101 MIDDLESEX TPKE
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01803-4914
Practice Address - Country:US
Practice Address - Phone:781-270-7800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3906152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0369438Medicaid
MA0369438Medicaid
MAU58625Medicare UPIN