Individual provider Active NPI

Kit Tung Ip, OD

  • Optometrist
  • Boston, MA
National Provider Identifier
1972768075
Registry record updated May 27, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
4687 Issued in MA
Practice address
50 Staniford St
Suite 600
Boston, MA 02114-2517
Phone
(617) 367-4800
Fax
(617) 723-7028
NPI assigned
Jul 28, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 27, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 4687 MA Primary

Addresses

Primary practice location

50 Staniford St
Suite 600
Boston, MA 02114-2517

Mailing address

1125 Commonwealth Ave
Apt 19
Allston, MA 02134-3201
Phone (617) 447-7523

Other identifiers 1

IdentifierTypeStateIssuer
110080806AMedicaidMA

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
I20081215000528 MA Practitioner - Optometry 3476615121 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Practice roles

OrganizationSpecialtyStatusNew patients
Cambridge Eye Group Inc Optometrist CurrentSince Oct 21, 2016 Accepting new patients

Locations

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

Organizations & group practices 1

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": "1217203200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1464307200000",
    "number": "1972768075",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1125 COMMONWEALTH AVE",
            "address_2": "APT 19",
            "city": "ALLSTON",
            "state": "MA",
            "postal_code": "021343201",
            "telephone_number": "617-447-7523"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "50 STANIFORD ST",
            "address_2": "SUITE 600",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021142517",
            "telephone_number": "617-367-4800",
            "fax_number": "617-723-7028"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IP",
        "first_name": "KIT",
        "middle_name": "TUNG",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-07-28",
        "last_updated": "2016-05-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MA",
            "license": "4687",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110080806A",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Boston, MA

Sources for this page

Verify at the official NPI Registry.