Basic Information
| Provider Information | |||||||||
| NPI: | 1184624082 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHIN | ||||||||
| FirstName: | JASON | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | OD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 930 COMMONWEALTH AVE | ||||||||
| Address2: | SUITE 2 NEW ENGLAND EYE INSTITUTE | ||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 02215 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6175875511 | ||||||||
| FaxNumber: | 6172366323 | ||||||||
| Practice Location | |||||||||
| Address1: | 930 COMMONWEALTH AVE | ||||||||
| Address2: | SUITE 2A NEW ENGLAND EYE COMMONWEALTH | ||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 02215 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6172622020 | ||||||||
| FaxNumber: | 6172366323 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/21/2005 | ||||||||
| LastUpdateDate: | 03/05/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 4411 | MA | Y | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 000000037211 | 01 | BMC HEALTHNET | OTHER | 0701441 | 01 | MASS HEALTH | OTHER | 701441 | 05 | MA | MEDICAID | 5594616 | 01 | FIRST HEALTH | OTHER | W17559 | 01 | MEDICARE | OTHER | AA26386 | 01 | HARVARD PILGRIM | OTHER | 495654 | 01 | TUFTS | OTHER | W16412 | 01 | BCBS | OTHER | 35226 | 01 | NHP | OTHER | 3796048 | 01 | AETNA | OTHER | 9695610 | 01 | CIGNA | OTHER | MA4411 | 01 | EYEMED | OTHER |