Active NPI
Kerry Lee Griebenow, O.D.
- Corneal and Contact Management Optometrist
- New London, WI
National Provider Identifier
1063487072
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Corneal and Contact Management Optometrist
- License
- 1666
- Practice address
- 105 Northridge Dr
New London, WI 54961-2703 - Phone
- (920) 982-3711
- Fax
- (920) 982-3009
- NPI assigned
- Feb 22, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Corneal and Contact Management Optometrist | 152WC0802X | 1666 | WI | Primary |
Addresses
Primary practice location
105 Northridge Dr
New London, WI 54961-2703
Mailing address
105 Northridge Dr
P.O. Box 230
New London, WI 54961-2703
Phone (920) 982-3711
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 38510500 | Medicaid | WI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1666 | WI | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1140566400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1783900800000",
"number": "1063487072",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "105 NORTHRIDGE DR",
"address_2": "P.O. BOX 230",
"city": "NEW LONDON",
"state": "WI",
"postal_code": "549612703",
"telephone_number": "920-982-3711",
"fax_number": "920-982-3009"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "105 NORTHRIDGE DR",
"city": "NEW LONDON",
"state": "WI",
"postal_code": "549612703",
"telephone_number": "920-982-3711",
"fax_number": "920-982-3009"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRIEBENOW",
"first_name": "KERRY",
"middle_name": "LEE",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-02-22",
"last_updated": "2026-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "152WC0802X",
"taxonomy_group": "",
"desc": "Optometrist, Corneal and Contact Management",
"state": "WI",
"license": "1666",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "38510500",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in New London, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.