Individual provider Active NPI

Monica Diem Phuong Nguyen, O.D.

  • Optometrist
  • Boston, MA
National Provider Identifier
1134475502
Registry record updated Jul 26, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
5059 Issued in MA
Practice address
1340 Boylston St # 6F
Boston, MA 02215-4302
Phone
(617) 927-6190
Fax
(617) 236-4262
NPI assigned
Aug 3, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 26, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 5059 MA Primary

Addresses

Primary practice location

1340 Boylston St # 6F
Boston, MA 02215-4302

Mailing address

12 Revere PL
Medford, MA 02155-3903
Phone (225) 284-6030

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20141222000890 MA Practitioner - Optometry 9436308475 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
University of Houston - College of Optometry, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Fenway Community Health Center, IncGroup PAC ID 0941299655, 79 clinicians
Redstone Eye Associates LLCGroup PAC ID 7517911092, 5 clinicians

Practice addresses (Care Compare)

1340 Boylston St
Boston, MA 02215-4302
Phone (617) 267-0900

75 Main St
Stoneham, MA 02180-3305
Phone (781) 438-3372

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
5059MAMDSurgical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Family Eye Care Associates Optometrist CurrentSince Jul 13, 2025 Accepting new patients
Fenway Community Health Center, Inc CurrentSince Jul 12, 2021 Accepting new patients
Tufts Medical Center, Inc. CurrentSince Jun 13, 2017 Accepting new patients
Emerson Practice Associates, Inc. CurrentSince Apr 25, 2021 Accepting new patients
Fenway Community Health Center, Inc CurrentSince Jul 12, 2021 Accepting new patients
Redstone Eye Associates, LLC Optometrist CurrentSince Jan 1, 2021 Accepting new patients
Tufts Medical Center, Inc. CurrentSince Jun 13, 2017 Accepting new patients
Fenway Community Health Center, Inc PastSince May 1, 2022 Accepting new patients

Locations

3000 Forsythe Ave
Monroe, LA 71201
Phone (318) 325-9474

1340 Boylston St
Boston, MA 02215
Phone (617) 267-0900

750 Washington St
#833
Boston, MA 02111
Phone (617) 636-4800

1340 Boylston St
#6F
Boston, MA 02215
Phone (617) 927-6190

800 Washington St
Boston, MA 02111
Phone (617) 636-4800

800 Washington St
#1013
Boston, MA 02111
Phone (617) 636-0491

133 Ornac
Concord, MA 01742
Phone (978) 287-3000

75 Main St
Stoneham, MA 02180
Phone (781) 438-2505

Interoperability endpoints

  • Direct secure messaging: mnguyen20323@direct.ctc.masshiway.net

Organizations & group practices 8

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.

NPI Registry JSON

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

{
    "created_epoch": "1343952000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1627257600000",
    "number": "1134475502",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12 REVERE PL",
            "city": "MEDFORD",
            "state": "MA",
            "postal_code": "021553903",
            "telephone_number": "225-284-6030"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1340 BOYLSTON ST # 6F",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "022154302",
            "telephone_number": "617-927-6190",
            "fax_number": "617-236-4262"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NGUYEN",
        "first_name": "MONICA",
        "middle_name": "DIEM PHUONG",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-08-03",
        "last_updated": "2021-07-26",
        "certification_date": "2021-07-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MA",
            "license": "5059",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boston, MA

Sources for this page

Verify at the official NPI Registry.