Provider Demographics
NPI:1104843168
Name:BRESNAHAN, STEVEN DAVID (OD)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:DAVID
Last Name:BRESNAHAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:201 NW RENFRO ST
Mailing Address - Street 2:
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-4113
Mailing Address - Country:US
Mailing Address - Phone:817-295-5601
Mailing Address - Fax:817-295-1884
Practice Address - Street 1:201 NW RENFRO ST
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-4113
Practice Address - Country:US
Practice Address - Phone:817-295-5601
Practice Address - Fax:817-295-1884
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-16
Last Update Date:2014-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5612T152WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WP0200XEye and Vision Services ProvidersOptometristPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU95216Medicare UPIN