Provider Demographics
NPI:1518942929
Name:UNDERKOFFLER, JEFFREY R (OD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:R
Last Name:UNDERKOFFLER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 NEPONSET ST FL STREET12
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01606-2714
Mailing Address - Country:US
Mailing Address - Phone:508-856-9599
Mailing Address - Fax:508-854-4997
Practice Address - Street 1:5 NEPONSET ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01606-2714
Practice Address - Country:US
Practice Address - Phone:508-856-9599
Practice Address - Fax:508-854-4997
Is Sole Proprietor?:No
Enumeration Date:2005-12-08
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3386152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
7926634OtherAETNA US HEALTHCARE
B21211501OtherCIGNA HEALTH PLAN
0323837OtherWELFARE
61202OtherFALLON COMMUNITY HEALTH
MA0323837Medicaid
W15817OtherBLUE SHIELD HMO BLUE
042472266OtherPRIVATE HEALTHCARE SYSTEM
5901866OtherCIGNA HEALTH PLAN
AA3020OtherHARVARD PILGRIM HEALTHCAR
786730OtherMVP HEALTH CARE
35371OtherCHILDRENS MEDICAL SECURIT
W15817OtherBLUE SHIELD INDEMNITY
042472266OtherTHREE RIVERS
2213190OtherFIRST HEALTH
35371OtherHEALTHY START
W15817OtherBLUE CARE ELECT
5901866OtherCIGNA HEALTH PLAN
410045334Medicare ID - Type UnspecifiedRAILROAD
MA0323837Medicaid
W15817OtherBLUE CARE ELECT