KIMBERLEY W. CHAN O.D.
NPI 1104908458
Optometrist - Pediatrics in Boston, MA
About Kimberley W. Chan O.d. NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
KIMBERLEY W. CHAN O.D. (NPI 1104908458) is an individual pediatrics provider in Boston, Massachusetts, licensed in Massachusetts (4522) and active in the NPI registry since October 2006. She is enrolled in Medicare PECOS.
NPPES Registry Identity
Specialties & Licenses
Other Identifiers 1
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Kimberley W. Chan O.d. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Billing Reassignment
Medicare enrollment records show Kimberley Chan reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
Boston, MA 02115
- Reassigned Medicare billing, Massachusetts enrollment
- 71 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Physician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 02114 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
Other Providers at the Same Location NPPES 20
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
BOSTON, MA 02114
BOSTON, MA 02114
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Kimberley Chan's NPI number?
The NPI number for Kimberley Chan is 1104908458. It was assigned to this individual provider in the NPPES registry on October 19, 2006.
Where is Kimberley Chan located?
Kimberley Chan practices at 243 Charles St, Boston, MA 02114. The listed phone number is (617) 573-4169.
What is Kimberley Chan's specialty?
The primary specialty registered for this NPI is Optometrist, specializing in Pediatrics, with taxonomy code 152WP0200X.
Is Kimberley Chan enrolled in Medicare?
Yes. Kimberley Chan is registered in the Medicare PECOS enrollment system.
Which organization bills Medicare for Kimberley Chan's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Kimberley Chan reassigns Medicare benefits to Childrens Hospital Ophthalmology Foundation Inc (Boston, MA). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Kimberley Chan's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
When was this NPI record last updated?
The NPPES record for Kimberley Chan was last updated on July 8, 2007. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 19 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Kimberley W. Chan, O.D. · NPI 1104908458
Pediatrics provider in Boston, Massachusetts. Individual provider, active in the CMS NPPES registry since October 19, 2006.
## Identity
- **NPI:** 1104908458 (Entity type: Individual)
- **Enumerated:** October 19, 2006
- **Primary specialty:** Optometrist - Pediatrics · taxonomy 152WP0200X
- **State license:** 4522 (Massachusetts)
- **Sole proprietor:** No
## Practice location
- **Address:** 243 CHARLES ST, Boston, MA 02114-3002
- **Phone:** (617) 573-4169
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health
- **Bills Medicare through:** Childrens Hospital Ophthalmology Foundation Inc (NPI 1770679045, Boston, MA), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** July 8, 2007
- **Other identifiers:** Other W16452 (MA)
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Source: [NPI Profile](https://npiprofile.com/npi/1104908458) · Data from the CMS NPPES public registry.