Provider Demographics
NPI:1972768075
Name:IP, KIT TUNG (OD)
Entity Type:Individual
Prefix:
First Name:KIT
Middle Name:TUNG
Last Name:IP
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1125 COMMONWEALTH AVE
Mailing Address - Street 2:APT 19
Mailing Address - City:ALLSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02134-3201
Mailing Address - Country:US
Mailing Address - Phone:617-447-7523
Mailing Address - Fax:
Practice Address - Street 1:50 STANIFORD ST
Practice Address - Street 2:SUITE 600
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2517
Practice Address - Country:US
Practice Address - Phone:617-367-4800
Practice Address - Fax:617-723-7028
Is Sole Proprietor?:No
Enumeration Date:2008-07-28
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA4687152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110080806AMedicaid
MA000856701Medicare PIN
MA000856702Medicare PIN