Healthcare Provider Details

I. General information

NPI: 1124613542
Provider Name (Legal Business Name): APPLETON EYE ASSOCIATES P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2021
Last Update Date: 03/08/2021
Certification Date: 01/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 MARKET STREET SUITE 100
IPSWICH MA
01938
US

IV. Provider business mailing address

21 MARKET STREET SUITE 100
IPSWICH MA
01938
US

V. Phone/Fax

Practice location:
  • Phone: 978-356-3015
  • Fax: 978-356-7525
Mailing address:
  • Phone: 978-356-3015
  • Fax: 978-356-7525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: KEVIN MICHAEL GASIOROWSKI
Title or Position: OWNER
Credential: DO
Phone: 978-465-8761