Individual
DR. NICHOLAS MATTHEW KOFOS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
180 BOLTON ST, MARLBOROUGH, MA 01752-3934
(508) 485-0736
(508) 481-7532
Mailing address
180 BOLTON ST, MARLBOROUGH, MA 01752-3934
(508) 485-0736
(508) 481-7532
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
3264
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0392227
—
MA
01
—
772575
TUFTS
MA
01
—
U47255
HARVARD PILGRIM
MA
Enumeration date
09/02/2005
Last updated
05/07/2012
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