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General NPI Number Information
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NPI Number | 1164846259
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Entity Type | Organization
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Legal Business Name | STEVEN D BRESNAHAN
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Dates
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Enumeration Date | 02/10/2014
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Last Update Date | 02/10/2014
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Provider Practice Location Address
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Address Line | 6614 TOWNLAKE CIR
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City | ARLINGTON
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State | TX
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Zip | 76016-2550
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Country | US
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Telephone | 817-295-5601
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Fax | 817-295-1884
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Provider Business Mailing Address
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Address Line | 201 NW RENFRO ST
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City | BURLESON
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State | TX
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Zip | 76028-4113
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Country | US
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Telephone | 817-295-5601
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Fax | 817-295-1884
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Authorized Official
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Title or Position | OWNER
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Name | STEVEN D BRESNAHAN
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Credential | OD
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Telephone | 817-295-5601
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 5612TG
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License Number State | TX
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