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NPI Code Detail

MEDICARE: DR. HOLGER LEONARD BRENCHER O.D., MS, BA

MEDICARE: DR. HOLGER LEONARD BRENCHER O.D., MS, BA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometrist3436NY

General Provider Information

NPI Number : 1205827284
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. HOLGER LEONARD BRENCHER O.D., MS, BA
Provider Business Mailing Address
First Line : 25139 COUNTY ROUTE 37
Second Line :
City : CARTHAGE
State : NY
Zip : 13619-3347
Country : US
Telephone Number : 315-493-4348
Fax Number :
Provider Business Practice Location Address
First Line : USA MEDDAC OPTOMETRY CLINIC
Second Line : 11050 MT BELVEDERE BLVD
City : FORT DRUM
State : NY
Zip : 13602-5004
Country : US
Telephone Number : 315-772-1801
Fax Number : 315-772-0700
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/31/2005
Last Update Date : 07/08/2007

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