MEDICARE: BRIAN EUGENE BLEILER OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	VUT005098	NY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	410020897	OTHER		RR MEDICARE

General Provider Information

NPI Number	:	1255327854
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN EUGENE BLEILER OD

Provider Business Mailing Address
First Line	:	207 MADISON AVE
Second Line	:
City	:	ELMIRA
State	:	NY
Zip	:	14901-3204
Country	:	US
Telephone Number	:	607-734-2984
Fax Number	:	607-398-3411

Provider Business Practice Location Address
First Line	:	406 E 4TH ST
Second Line	:
City	:	WATKINS GLEN
State	:	NY
Zip	:	14891-1217
Country	:	US
Telephone Number	:	607-535-4842
Fax Number	:	607-398-3413

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2005
Last Update Date	:	01/25/2012

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