Provider Demographics
NPI:1255575304
Name:HALEPASKA, KENDRA M (OD)
Entity type:Individual
Prefix:
First Name:KENDRA
Middle Name:M
Last Name:HALEPASKA
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 1:110 CAMBRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22405-1924
Mailing Address - Country:US
Mailing Address - Phone:540-371-2020
Mailing Address - Fax:540-373-0141
Practice Address - Street 1:4516 PLANK RD
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22407-0147
Practice Address - Country:US
Practice Address - Phone:540-371-2020
Practice Address - Fax:540-373-0141
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-20
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618001830152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist