Provider Demographics
NPI:1205827284
Name:BRENCHER, HOLGER LEONARD (OD, MS, BA)
Entity Type:Individual
Prefix:DR
First Name:HOLGER
Middle Name:LEONARD
Last Name:BRENCHER
Suffix:
Gender:M
Credentials:OD, MS, BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25139 COUNTY ROUTE 37
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:NY
Mailing Address - Zip Code:13619-3347
Mailing Address - Country:US
Mailing Address - Phone:315-493-4348
Mailing Address - Fax:
Practice Address - Street 1:USA MEDDAC OPTOMETRY CLINIC
Practice Address - Street 2:11050 MT BELVEDERE BLVD
Practice Address - City:FORT DRUM
Practice Address - State:NY
Practice Address - Zip Code:13602-5004
Practice Address - Country:US
Practice Address - Phone:315-772-1801
Practice Address - Fax:315-772-0700
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3436152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist