NPIMap

Organization Active NPI

Cambridge Eye Group Inc

  • Optometrist
  • Cambridge, MA
National Provider Identifier
1235688557
Registry record updated Sep 27, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
4689 Issued in MA
Legal business name
CAMBRIDGE EYE GROUP INC
Practice address
603 Concord Ave
Suite B
Cambridge, MA 02138-1197
Phone
(617) 818-0476
NPI assigned
Sep 27, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 27, 2016

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

Authorized official

Name
Jacky KongNPI 1851556021
Title
President
Phone
(617) 818-0476

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 152W00000X 4689 MA Primary
Corneal and Contact Management OptometristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 152WC0802X 4687 MA
Pediatric OptometristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 152WP0200X 4689 MA
Sports Vision OptometristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 152WS0006X 4689 MA
Vision Therapy OptometristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 152WV0400X 4689 MA

Addresses

Primary practice location

603 Concord Ave
Suite B
Cambridge, MA 02138-1197

Mailing address

169 Monsignor Obrien Hwy
415
Cambridge, MA 02141-1289

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20161128000724 MA Part B Supplier - Clinic/Group Practice 3779862206 Receives reassigned benefits from 4 practitioners
Practice locations: Cambridge, MA

National Provider Directory

National Provider Directory
Tax ID family
Cambridge Eye Group Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

354 Pleasant St
Belmont, MA 02478
Phone (617) 818-0476

603 Concord Ave
Ste B
Cambridge, MA 02138
Phone (617) 818-0476

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1474934400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1474934400000",
    "number": "1235688557",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "169 MONSIGNOR OBRIEN HWY",
            "address_2": "415",
            "city": "CAMBRIDGE",
            "state": "MA",
            "postal_code": "021411289"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "603 CONCORD AVE",
            "address_2": "SUITE B",
            "city": "CAMBRIDGE",
            "state": "MA",
            "postal_code": "021381197",
            "telephone_number": "617-818-0476"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAMBRIDGE EYE GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-09-27",
        "last_updated": "2016-09-27",
        "status": "A",
        "authorized_official_last_name": "KONG",
        "authorized_official_first_name": "JACKY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "617-818-0476"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "MA",
            "license": "4689",
            "primary": true
        },
        {
            "code": "152WC0802X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": "MA",
            "license": "4687",
            "primary": false
        },
        {
            "code": "152WP0200X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist, Pediatrics",
            "state": "MA",
            "license": "4689",
            "primary": false
        },
        {
            "code": "152WS0006X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist, Sports Vision",
            "state": "MA",
            "license": "4689",
            "primary": false
        },
        {
            "code": "152WV0400X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist, Vision Therapy",
            "state": "MA",
            "license": "4689",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cambridge, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.