Provider Demographics
NPI:1336782986
Name:ZAWORSKI, PENNY S
Entity Type:Individual
Prefix:MS
First Name:PENNY
Middle Name:S
Last Name:ZAWORSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:806 N OLD WORLD 3RD ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53203-1701
Mailing Address - Country:US
Mailing Address - Phone:414-276-7217
Mailing Address - Fax:
Practice Address - Street 1:806 N OLD WORLD 3RD ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53203-1701
Practice Address - Country:US
Practice Address - Phone:414-276-7217
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-25
Last Update Date:2019-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty