Provider Demographics
NPI:1396797908
Name:KAWABATA, CLAUDINE Y (OD)
Entity type:Individual
Prefix:
First Name:CLAUDINE
Middle Name:Y
Last Name:KAWABATA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:50 STANIFORD ST STE 600
Mailing Address - Street 2:OPHTHALMIC CONSULTANTS OF BOSTON
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-2517
Mailing Address - Country:US
Mailing Address - Phone:617-367-4800
Mailing Address - Fax:617-589-3905
Practice Address - Street 1:50 STANIFORD ST STE 600
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2517
Practice Address - Country:US
Practice Address - Phone:617-367-4800
Practice Address - Fax:617-723-7028
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4219152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0324060Medicaid
465385OtherTUFTS HEALTH PLAN
MAW16284OtherBLUE CROSS BLUE SHIELD
152609OtherHARVARD PILGRIM HEALTH PL
465385OtherTUFTS HEALTH PLAN
152609OtherHARVARD PILGRIM HEALTH PL