Provider Demographics
NPI:1083828917
Name:APPLETON EYE ASSOCIATES PC
Entity Type:Organization
Organization Name:APPLETON EYE ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:GASIOROWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:978-465-8761
Mailing Address - Street 1:8 GREAT POND RD
Mailing Address - Street 2:
Mailing Address - City:WENHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01984-1504
Mailing Address - Country:US
Mailing Address - Phone:978-468-0278
Mailing Address - Fax:978-465-6228
Practice Address - Street 1:39 GREEN ST
Practice Address - Street 2:
Practice Address - City:NEWBURYPORT
Practice Address - State:MA
Practice Address - Zip Code:01950-2652
Practice Address - Country:US
Practice Address - Phone:978-465-8761
Practice Address - Fax:978-465-6228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3623152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0391727Medicaid
MA0391727Medicaid
MA454558Medicare ID - Type Unspecified