Provider Demographics
NPI:1730349374
Name:FRED J. BRESLER O.D.P.C.
Entity type:Organization
Organization Name:FRED J. BRESLER O.D.P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FRED
Authorized Official - Middle Name:J
Authorized Official - Last Name:BRESLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-782-2600
Mailing Address - Street 1:1246 ARSENAL ST
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-2214
Mailing Address - Country:US
Mailing Address - Phone:315-782-2600
Mailing Address - Fax:315-782-3010
Practice Address - Street 1:1246 ARSENAL ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-2214
Practice Address - Country:US
Practice Address - Phone:315-782-2600
Practice Address - Fax:315-782-3010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-16
Last Update Date:2010-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV 003336152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0645220001Medicare NSC