Provider Demographics
NPI:1992983894
Name:MATTHEW J. KAIM
Entity type:Organization
Organization Name:MATTHEW J. KAIM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:J
Authorized Official - Last Name:KAIM
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:617-846-1734
Mailing Address - Street 1:50 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:WINTHROP
Mailing Address - State:MA
Mailing Address - Zip Code:02152-2649
Mailing Address - Country:US
Mailing Address - Phone:617-846-1734
Mailing Address - Fax:617-846-3292
Practice Address - Street 1:50 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:WINTHROP
Practice Address - State:MA
Practice Address - Zip Code:02152-2649
Practice Address - Country:US
Practice Address - Phone:617-846-1734
Practice Address - Fax:617-846-3292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-04
Last Update Date:2009-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3084152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0862810001Medicare NSC