Provider Demographics
NPI:1578658068
Name:HAEFS, KURT A (OD)
Entity Type:Individual
Prefix:DR
First Name:KURT
Middle Name:A
Last Name:HAEFS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:W.343S.9745 RED BRAE DRIVE
Mailing Address - Street 2:
Mailing Address - City:MUKWONAGO
Mailing Address - State:WI
Mailing Address - Zip Code:53149
Mailing Address - Country:US
Mailing Address - Phone:414-322-7764
Mailing Address - Fax:
Practice Address - Street 1:6701 S. 27TH STREET
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:WI
Practice Address - Zip Code:53132
Practice Address - Country:US
Practice Address - Phone:414-761-9581
Practice Address - Fax:414-761-9583
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2428152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist