Individual
DR. KERRY LEE GRIEBENOW
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
105 NORTHRIDGE DR, NEW LONDON, WI 54961-2703
(920) 982-3711
(920) 982-3009
Mailing address
105 NORTHRIDGE DR, P.O. BOX 230, NEW LONDON, WI 54961-2703
(920) 982-3711
(920) 982-3009
Taxonomy
Speciality
Code
Description
License number
State
152WC0802X
Corneal and Contact Management Optometrist
Primary
1666
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
38510500
—
WI
Enumeration date
02/22/2006
Last updated
07/08/2007
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