Provider Demographics
NPI:1699001222
Name:MAURSETTER, CALLIE MP (OD)
Entity type:Individual
Prefix:DR
First Name:CALLIE
Middle Name:MP
Last Name:MAURSETTER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:CALLIE
Other - Middle Name:M
Other - Last Name:PEOTTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:3225 E WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53704-4361
Mailing Address - Country:US
Mailing Address - Phone:612-963-3937
Mailing Address - Fax:
Practice Address - Street 1:3225 E WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53704-4361
Practice Address - Country:US
Practice Address - Phone:608-249-5548
Practice Address - Fax:608-249-5548
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-02
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3161-035152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist