Basic Information
| Provider Information | |||||||||
| NPI: | 1699757666 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | UNDERKOFFLER | ||||||||
| FirstName: | KARIN | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | OD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 900 UNION ST | ||||||||
| Address2: | |||||||||
| City: | WESTBOROUGH | ||||||||
| State: | MA | ||||||||
| PostalCode: | 015815408 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5088569599 | ||||||||
| FaxNumber: | 5088710779 | ||||||||
| Practice Location | |||||||||
| Address1: | 900 UNION ST | ||||||||
| Address2: | |||||||||
| City: | WESTBOROUGH | ||||||||
| State: | MA | ||||||||
| PostalCode: | 015815408 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5088711799 | ||||||||
| FaxNumber: | 5088710779 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/16/2005 | ||||||||
| LastUpdateDate: | 06/23/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/23/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 3378 | MA | Y | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 042472266 | 01 | THREE RIVERS | OTHER | 35481174 | 01 | CIGNA HEALTHSOURCE | OTHER | 60676 | 01 | CHILDRENS MEDICAL SECURIT | OTHER | 0334979 | 01 | MEDICAID WELFARE | OTHER | 110014770A | 05 | MA | MEDICAID | W16361 | 01 | BLUE SHIELD INDEMNITY | OTHER | 042472266 | 01 | TRICARE CHAMPUS | OTHER | 042472266 | 01 | PRIVATE HEALTHCARE SYSTEM | OTHER | 786731 | 01 | MVP HEALTH CARE | OTHER | B21204901 | 01 | CIGNA HEALTH PLAN | OTHER | 61203 | 01 | FALLON COMMUNITY HEALTH P | OTHER | 7023611 | 01 | AETNA US HEALTHCARE | OTHER | W16361 | 01 | BLUE CARE ELECT | OTHER | 2213192 | 01 | FIRST HEALTH | OTHER | AA3021 | 01 | HARVARD PILGRIM HEALTHCAR | OTHER | W17198 | 01 | MEDICARE B | OTHER | 410045265 | 01 | RAILROAD MEDICARE | OTHER | W16361 | 01 | BLUE SHIELD HMO BLUE | OTHER | 6356724001 | 01 | CIGNA PAL ID | OTHER |