Kimberley W. Chan, O.D.

Primary specialty

Pediatric OptometristTaxonomy code 152WP0200X

License

4522 Issued in MA

Practice address

243 Charles St
Boston, MA 02114-3002

Phone

(617) 573-4169

NPI assigned

Oct 19, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kchan31006@direct.bostonchildrens.org

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Childrens Hospital Ophthalmology Foundation Inc

  • Ophthalmology Physician
  • Boston, MA
  • NPI 1770679045
  Medicare reassignment NPD
• Children'S Hospital Pediatric Associates, Inc

  • Pediatrics Physician
  • Boston, MA
  • NPI 1457306664
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161216000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1104908458",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "243 CHARLES ST",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021143002",
            "telephone_number": "617-573-4169"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "243 CHARLES ST",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021143002",
            "telephone_number": "617-573-4169"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHAN",
        "first_name": "KIMBERLEY",
        "middle_name": "W.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-19",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152WP0200X",
            "taxonomy_group": "",
            "desc": "Optometrist, Pediatrics",
            "state": "MA",
            "license": "4522",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PROVIDER ID",
            "identifier": "W16452",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jung E Chan, O.D.
• Katherine Redfield Chan, MD
• Kevin E Chan, M.D.
• Kevin J Chan, MD
• Kimberley Marie Chan, DMD
• Kit Chan, MD
• Lan Chan, MD
• Leana Y Chan, NP
• Livia Chan
• Mandy Chan

• Pediatric Optometrist in Boston, MA
• Providers in Boston, MA by specialty
• Pediatric Optometrist in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.