Individual provider Active NPI

Vivienne Therese Kong, OD

  • Optometrist
  • Chelmsford, MA
National Provider Identifier
1366434441
Registry record updated Nov 14, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
3434 Issued in MA
Practice address
19 Village SQ
Chelmsford, MA 01824-2712
Phone
(978) 256-5600
Fax
(978) 703-0250
NPI assigned
Aug 16, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 14, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 3434 MA Primary

Addresses

Primary practice location

19 Village SQ
Chelmsford, MA 01824-2712

Mailing address

Massachusetts Eye Associates PC
19 Village Square
Chelmsford, MA 01824-2712
Phone (978) 256-5600

Other identifiers 1

IdentifierTypeStateIssuer
0354228MedicaidMA

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
I20111114000329 MA Practitioner - Optometry 3779757505 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Massachusetts Eye Associates PC CurrentSince Apr 1, 1990 Accepting new patients
Massachusetts Eye Associates PC Optometrist CurrentSince Apr 1, 1990 Accepting new patients

Locations

19 Village Sq
Chelmsford, MA 01824
Phone (978) 256-5600

33 Bartlett St
Ste 101
Lowell, MA 01852
Phone (978) 256-5600

500 Clark Rd
Ste 3B
Tewksbury, MA 01876
Phone (978) 256-5600

Organizations & group practices 2

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.

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
New England College of Optometry
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Massachusetts Eye Associates PC 13 clinicians

Practice addresses (Care Compare)

19 Village SQ
Chelmsford, MA 01824-2712
Phone (978) 256-5600

NPI Registry JSON

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

{
    "created_epoch": "1124150400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1194998400000",
    "number": "1366434441",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "MASSACHUSETTS EYE ASSOCIATES PC",
            "address_2": "19 VILLAGE SQUARE",
            "city": "CHELMSFORD",
            "state": "MA",
            "postal_code": "018242712",
            "telephone_number": "978-256-5600",
            "fax_number": "978-703-0250"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19 VILLAGE SQ",
            "city": "CHELMSFORD",
            "state": "MA",
            "postal_code": "018242712",
            "telephone_number": "978-256-5600",
            "fax_number": "978-703-0250"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KONG",
        "first_name": "VIVIENNE",
        "middle_name": "THERESE",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-08-16",
        "last_updated": "2007-11-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MA",
            "license": "3434",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0354228",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chelmsford, MA

Sources for this page

Verify at the official NPI Registry.