DR. KERRY LEE GRIEBENOW (NPI# 1063487072) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1063487072 |
| Entity Type | Individual |
| Full Name | DR. KERRY LEE GRIEBENOW |
| Credential | O.D. |
| Practice Address |
105 Northridge Dr New London WI 54961-2703 |
| Mailing Address |
105 Northridge Dr P.o. Box 230 New London WI 54961-2703 |
| Practice Telephone | 9209823711 |
| Practice Fax Number | 9209823009 |
| Mailing Telephone | 9209823711 |
| Mailing Fax Number | 9209823009 |
| Enumeration Date | 2006-02-22 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | X |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 152WC0802X |
Optometrist Specialization: Corneal and Contact Management |
1666 | WI | Eye and Vision Services Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WI | 38510500 | 05 |
| Street Address |
105 NORTHRIDGE DR |
| City | NEW LONDON |
| State | WI |
| Zip Code | 54961-2703 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992234595 | Molly Benck | Optometrist | 105 Northridge Dr, New London, WI 54961-2703 | 2017-06-07 |
| 1770712903 | Craig E Sylte | Optometrist | 105 Northridge Dr, New London, WI 54961-2703 | 2009-07-09 |
| 1275637803 | Michael James Lawton | Dentist | 105 Northridge Dr, New London, WI 54961-2703 | 2006-09-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407406408 | Cheryl Schneider | Technician | L 56 Northgate Estates, New London, WI 54961 | 2019-09-12 |
| 1861634719 | Rebecca L Kramer | Counselor | 315 Burton St, New London, WI 54961 | 2009-03-24 |
| 1598913501 | Marsha Ann Nytes | Licensed Practical Nurse | E8222 Weyawega Rd, New London, WI 54961 | 2008-09-03 |
| 1659585172 | Amanda L. Beck | Physical Therapy Assistant | 400 E. 4th Street, Manawa, WI 54961 | 2007-05-10 |
| 1366599433 | Griebenow Eyecare, S.c. | Optometrist | 105 Northridge Drive, New London, WI 54961 | 2007-01-04 |
| 1740822055 | Lauren Mae Flunker | Social Worker | E7475 Rawhide Rd, New London, WI 54961 | 2019-10-09 |
| 1063641249 | Forefront Dermatology, S.c. | Dermatology | 1620 N Shawano St, Suite C, New London, WI 54961 | 2009-07-08 |
| 1093982530 | Ascension Medical Group-fox Valley Wisconsin, Inc | Clinic/Center | 1420 Algoma St, New London, WI 54961 | 2008-05-14 |
| 1821263849 | Mark Alan Tegtmeier | Counselor | E7475 Rawhide Rd, New London, WI 54961 | 2008-04-30 |
| 1194910489 | Laurie Mollenhauer | Physical Therapist | 1405 Mill St, New London, WI 54961 | 2007-09-10 |
| Find all providers in zip 54961 | ||||
| Taxonomy Code | 152WC0802X |
| Grouping | Eye and Vision Services Providers |
| Classification | Optometrist |
| Specialization | Corneal and Contact Management |
| The professional activities performed by an Optometrist related to the fitting of contact lenses to an eye, ongoing evaluation of the cornea’s ability to sustain successful contact lens wear, and treatment of any external eye or corneal condition which can affect contact lens wear. |
| Notes: Source: American Optometric Association [1/1/2009: added definition, added source] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053487124 | James L Healy | Optometrist | 1113 17th Ave, Monroe, WI 53566-2063 | 2006-11-28 |
| 1265513410 | Eye Care Centers of Wisconsin, S.c. | Optometrist | 355 N Peters Ave Ste 1, Fond Du Lac, WI 54935-8115 | 2006-10-17 |
| 1982705810 | Chad R Overman | Optometrist | 2401 Highway 14 East, Richland Center, WI 53581 | 2006-09-25 |
| 1487685988 | Jeffrey R Thomas | Optometrist | 2305 30th Ave, Kenosha, WI 53144-1411 | 2006-07-05 |
| 1407817752 | Mark F. Cook | Optometrist | 412 Highland Blvd, Johnson Creek, WI 53038-9504 | 2006-03-28 |
| 1215996723 | Steven Lee Nottleson | Optometrist | 1545 Main St, Marinette, WI 54143-1334 | 2006-03-22 |
| 1518949056 | Vision Clinic Dr. Savin & Associates | Optometrist | 1421 Washington Ave, Racine, WI 53403-2254 | 2005-11-18 |
| 1215182563 | Oscar Ortiz | Optometrist | 1 W Towne Mall, Madison, WI 53719-1019 | 2008-11-28 |
| 1508053083 | Romanak Vision Inc. | Optometrist | 7323 60th Ave, Kenosha, WI 53142-3542 | 2007-09-28 |
| 1235352667 | Lindman Eye Care LLC | Optometrist | 2644 N 8th St, Sheboygan, WI 53083-4921 | 2007-04-11 |
| Find all providers with the same taxonomy | ||||
| City | NEW LONDON |
| Zip Code | 54961 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.