Provider Demographics
NPI:1932142676
Name:HOLMBERG, KRISTER L (OD)
Entity type:Individual
Prefix:DR
First Name:KRISTER
Middle Name:L
Last Name:HOLMBERG
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2087 ARENA BLVD STE 120
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95834-2322
Mailing Address - Country:US
Mailing Address - Phone:916-419-8167
Mailing Address - Fax:916-419-6398
Practice Address - Street 1:2087 ARENA BLVD.
Practice Address - Street 2:SUITE 120
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95834
Practice Address - Country:US
Practice Address - Phone:916-419-8167
Practice Address - Fax:916-419-6398
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2015-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12692T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist