Provider Demographics
NPI:1184624082
Name:CHIN, JASON R (OD)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:R
Last Name:CHIN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:930 COMMONWEALTH AVE
Mailing Address - Street 2:SUITE 2 NEW ENGLAND EYE INSTITUTE
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215
Mailing Address - Country:US
Mailing Address - Phone:617-587-5511
Mailing Address - Fax:617-236-6323
Practice Address - Street 1:930 COMMONWEALTH AVE
Practice Address - Street 2:SUITE 2A NEW ENGLAND EYE COMMONWEALTH
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215
Practice Address - Country:US
Practice Address - Phone:617-262-2020
Practice Address - Fax:617-236-6323
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2009-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4411152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000037211OtherBMC HEALTHNET
0701441OtherMASS HEALTH
MA701441Medicaid
5594616OtherFIRST HEALTH
W17559OtherMEDICARE
AA26386OtherHARVARD PILGRIM
495654OtherTUFTS
W16412OtherBCBS
35226OtherNHP
3796048OtherAETNA
9695610OtherCIGNA
MA4411OtherEYEMED
5594616OtherFIRST HEALTH