NPIMap

Organization Active NPI

Jeffrey Kublin OD, PC

  • Optometrist
  • Boston, MA
National Provider Identifier
1629134085
Registry record updated Jul 1, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
3070 Issued in MA
Legal business name
JEFFREY KUBLIN OD, PC
Practice address
175 Cambridge St
Boston, MA 02114-2743
Phone
(617) 523-7006
Fax
(617) 523-5006
NPI assigned
Dec 29, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 1, 2009

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

Authorized official

Name
Jeffrey Kublin, ODNPI 1083630578
Title
Owner
Phone
(617) 523-7006

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X 3070 MA Primary

Addresses

Primary practice location

175 Cambridge St
Boston, MA 02114-2743

Mailing address

175 Cambridge St
Boston, MA 02114-2743
Phone (617) 523-7006

Other identifiers 1

IdentifierTypeStateIssuer
W20111OtherMABC/BS

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090414000688 MA Part B Supplier - Clinic/Group Practice 9537216361 Receives reassigned benefits from 5 practitioners
Practice locations: Boston, MA

National Provider Directory

National Provider Directory
Tax ID family
Jeffrey Kublin OD2 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.

Practitioners & affiliated clinicians

Practitioners 6

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": "1167350400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1246406400000",
    "number": "1629134085",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "175 CAMBRIDGE ST",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021142743",
            "telephone_number": "617-523-7006",
            "fax_number": "617-523-5006"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "175 CAMBRIDGE ST",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021142743",
            "telephone_number": "617-523-7006",
            "fax_number": "617-523-5006"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEFFREY KUBLIN OD, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-29",
        "last_updated": "2009-07-01",
        "status": "A",
        "authorized_official_last_name": "KUBLIN",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "617-523-7006",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "MA",
            "license": "3070",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS",
            "identifier": "W20111",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Boston, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2009; 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.