Provider Demographics
NPI:1699757666
Name:UNDERKOFFLER, KARIN L (OD)
Entity type:Individual
Prefix:
First Name:KARIN
Middle Name:L
Last Name:UNDERKOFFLER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 UNION ST
Mailing Address - Street 2:
Mailing Address - City:WESTBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01581-5408
Mailing Address - Country:US
Mailing Address - Phone:508-856-9599
Mailing Address - Fax:508-871-0779
Practice Address - Street 1:900 UNION ST
Practice Address - Street 2:
Practice Address - City:WESTBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01581-5408
Practice Address - Country:US
Practice Address - Phone:508-871-1799
Practice Address - Fax:508-871-0779
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3378152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
042472266OtherTHREE RIVERS
35481174OtherCIGNA HEALTHSOURCE
60676OtherCHILDRENS MEDICAL SECURIT
0334979OtherMEDICAID WELFARE
MA110014770AMedicaid
W16361OtherBLUE SHIELD INDEMNITY
042472266OtherTRICARE CHAMPUS
042472266OtherPRIVATE HEALTHCARE SYSTEM
786731OtherMVP HEALTH CARE
B21204901OtherCIGNA HEALTH PLAN
61203OtherFALLON COMMUNITY HEALTH P
7023611OtherAETNA US HEALTHCARE
W16361OtherBLUE CARE ELECT
2213192OtherFIRST HEALTH
AA3021OtherHARVARD PILGRIM HEALTHCAR
W17198OtherMEDICARE B
410045265OtherRAILROAD MEDICARE
W16361OtherBLUE SHIELD HMO BLUE
6356724001OtherCIGNA PAL ID
W17198Medicare ID - Type Unspecified