Healthcare Provider Details

I. General information

NPI: 1699757666
Provider Name (Legal Business Name): KARIN L UNDERKOFFLER OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2005
Last Update Date: 06/23/2020
Certification Date: 06/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 UNION ST
WESTBOROUGH MA
01581-5408
US

IV. Provider business mailing address

900 UNION ST
WESTBOROUGH MA
01581-5408
US

V. Phone/Fax

Practice location:
  • Phone: 508-871-1799
  • Fax: 508-871-0779
Mailing address:
  • Phone: 508-856-9599
  • Fax: 508-871-0779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3378
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: