1205827284 NPI number — DR. HOLGER LEONARD BRENCHER O.D., MS, BA

Table of content: DR. HOLGER LEONARD BRENCHER O.D., MS, BA (NPI 1205827284)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205827284 NPI number — DR. HOLGER LEONARD BRENCHER O.D., MS, BA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRENCHER
Provider First Name:
HOLGER
Provider Middle Name:
LEONARD
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
O.D., MS, BA
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205827284
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
25139 COUNTY ROUTE 37
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CARTHAGE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13619-3347
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
315-493-4348
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
USA MEDDAC OPTOMETRY CLINIC
Provider Second Line Business Practice Location Address:
11050 MT BELVEDERE BLVD
Provider Business Practice Location Address City Name:
FORT DRUM
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13602-5004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-772-1801
Provider Business Practice Location Address Fax Number:
315-772-0700
Provider Enumeration Date:
10/31/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  3436 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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