Healthcare Provider Details

I. General information

NPI: 1053934935
Provider Name (Legal Business Name): JOSEPHINE KO OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2020
Last Update Date: 12/23/2025
Certification Date: 12/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 MASSACHUSETTS AVE
ARLINGTON MA
02474-8621
US

IV. Provider business mailing address

60 MASSACHUSETTS AVE STE 1
ARLINGTON MA
02474-8621
US

V. Phone/Fax

Practice location:
  • Phone: 781-316-0141
  • Fax:
Mailing address:
  • Phone: 781-316-0141
  • Fax: 781-394-6107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number5442
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: