Provider Demographics
NPI:1619371572
Name:LIXIN ZHENG
Entity type:Organization
Organization Name:LIXIN ZHENG
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LIXIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ZHENG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:617-489-3790
Mailing Address - Street 1:466 TRAPELO RD
Mailing Address - Street 2:A
Mailing Address - City:BELMONT
Mailing Address - State:MA
Mailing Address - Zip Code:02478-1421
Mailing Address - Country:US
Mailing Address - Phone:617-489-3790
Mailing Address - Fax:617-489-1860
Practice Address - Street 1:466 TRAPELO RD
Practice Address - Street 2:A
Practice Address - City:BELMONT
Practice Address - State:MA
Practice Address - Zip Code:02478-1421
Practice Address - Country:US
Practice Address - Phone:617-489-3790
Practice Address - Fax:617-489-1860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-21
Last Update Date:2016-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4978152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA7353700001Medicare NSC