Provider Demographics
NPI:1689154429
Name:HOLLENBACH, KAITLYN HUEBSCH (OD, FAAO)
Entity type:Individual
Prefix:DR
First Name:KAITLYN
Middle Name:HUEBSCH
Last Name:HOLLENBACH
Suffix:
Gender:F
Credentials:OD, FAAO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 HENNEPIN AVE S APT 329
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55401-2478
Mailing Address - Country:US
Mailing Address - Phone:319-551-7615
Mailing Address - Fax:
Practice Address - Street 1:409 DUNLAP ST N
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-4201
Practice Address - Country:US
Practice Address - Phone:651-290-9200
Practice Address - Fax:651-290-9211
Is Sole Proprietor?:No
Enumeration Date:2018-08-21
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3650152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist