Provider Demographics
NPI:1366872418
Name:BRENCHER, HOLGER NIKOLAUS (OD)
Entity type:Individual
Prefix:
First Name:HOLGER
Middle Name:NIKOLAUS
Last Name:BRENCHER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3701 N MAIN ST
Mailing Address - Street 2:ATTN: VISION CENTER
Mailing Address - City:TAYLOR
Mailing Address - State:TX
Mailing Address - Zip Code:76574-4975
Mailing Address - Country:US
Mailing Address - Phone:617-634-9828
Mailing Address - Fax:
Practice Address - Street 1:3701 N MAIN ST
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:TX
Practice Address - Zip Code:76574-4975
Practice Address - Country:US
Practice Address - Phone:617-634-9828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-26
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8947TG152W00000X, 152WC0802X, 152WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management