Kerry Lee Griebenow O.D.

NPI 1063487072 - Optometrist - 152WC0802X

NPI Details
NPI 1063487072
Gender Male
Enumeration Date 02/22/2006
Last Updated 07/08/2007
Entity Type Individual
Active Over 10 years ago
Practice Location
105 NORTHRIDGE DR
NEW LONDON WI, 54961-2703, US
Phone (920) 982-3711
Fax (920) 982-3009
Business Location
105 NORTHRIDGE DR
P.O. BOX 230
NEW LONDON WI, 54961-2703, US
Phone (920) 982-3711
Fax (920) 982-3009
Toxanomy
Taxonomy Code 152WC0802X
License State Wisconsin
License Number 1666
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According to our database, Dr. Kerry Lee Griebenow O.D. NPI is 1063487072, taxonomy code is 152WC0802X and license number is 1666, license state is located at Wisconsin. Kerry Lee Griebenow O.D. physically located at 105 Northridge Dr, New London WI, 54961-2703. NPI Number Kerry Lee Griebenow O.D. has the Individual type.

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1063487072 NPI number is provided on an as is basis without warranty of any kind. 1063487072 is maintained by the National Plan & Provider Enumeration System. The contents of Kerry Lee Griebenow O.D. are for informational purposes only.