Provider Demographics
NPI:1356598080
Name:XU, MENG MENG (OD)
Entity type:Individual
Prefix:
First Name:MENG MENG
Middle Name:
Last Name:XU
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:109A DARTMOUTH STREET
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02216
Mailing Address - Country:US
Mailing Address - Phone:617-587-5511
Mailing Address - Fax:617-587-5511
Practice Address - Street 1:940 COMMONWEALTH AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-1203
Practice Address - Country:US
Practice Address - Phone:617-587-5511
Practice Address - Fax:617-587-5511
Is Sole Proprietor?:No
Enumeration Date:2008-08-25
Last Update Date:2009-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG002142152W00000X
MA4769152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist