Provider Demographics
NPI:1508962879
Name:GARBRECHT, KENDRA ERICKSON (OD)
Entity Type:Individual
Prefix:DR
First Name:KENDRA
Middle Name:ERICKSON
Last Name:GARBRECHT
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N4637 TIMBERCREST DR E
Mailing Address - Street 2:
Mailing Address - City:ONALASKA
Mailing Address - State:WI
Mailing Address - Zip Code:54650-8623
Mailing Address - Country:US
Mailing Address - Phone:608-799-4138
Mailing Address - Fax:608-781-1590
Practice Address - Street 1:2104 STATE ROAD 16
Practice Address - Street 2:
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54601-3046
Practice Address - Country:US
Practice Address - Phone:608-782-7127
Practice Address - Fax:608-782-7124
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02325152W00000X
WI3129-035152W00000X
MN3263152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1215110424OtherGROUP NPI
WI870360007OtherINDIVIDUAL PTAN
IAI17050Medicare PIN
IAI17029Medicare PIN
WI870360007OtherINDIVIDUAL PTAN
IAV08434Medicare UPIN