Individual
KIMBERLEY W. CHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
243 CHARLES ST, BOSTON, MA 02114-3002
(617) 573-4169
Mailing address
243 CHARLES ST, BOSTON, MA 02114-3002
(617) 573-4169
Taxonomy
Speciality
Code
Description
License number
State
152WP0200X
Pediatric Optometrist
Primary
4522
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
W16452
BCBS PROVIDER ID
MA
Enumeration date
10/19/2006
Last updated
07/08/2007
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