Healthcare Provider Details

I. General information

NPI: 1891925988
Provider Name (Legal Business Name): KAELYN K. ZAPORSKI CUMMINGS O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAELYN K. ZAPORSKI O.D.

II. Dates (important events)

Enumeration Date: 07/23/2009
Last Update Date: 03/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 E CHICAGO ST STE 100
MILWAUKEE WI
53202-5836
US

IV. Provider business mailing address

325 E CHICAGO ST STE 100
MILWAUKEE WI
53202-5836
US

V. Phone/Fax

Practice location:
  • Phone: 414-727-5888
  • Fax: 414-727-5889
Mailing address:
  • Phone: 414-727-5888
  • Fax: 414-727-5889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3152-035
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: