Provider Demographics
NPI:1003038316
Name:KRESSLEY, BROOK T (OD)
Entity Type:Individual
Prefix:
First Name:BROOK
Middle Name:T
Last Name:KRESSLEY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 POLO CLUB DR
Mailing Address - Street 2:
Mailing Address - City:MOON TWP
Mailing Address - State:PA
Mailing Address - Zip Code:15108-4709
Mailing Address - Country:US
Mailing Address - Phone:765-412-0246
Mailing Address - Fax:
Practice Address - Street 1:400 BROAD ST
Practice Address - Street 2:SUITE 2020
Practice Address - City:SEWICKLEY
Practice Address - State:PA
Practice Address - Zip Code:15143-1500
Practice Address - Country:US
Practice Address - Phone:412-741-4610
Practice Address - Fax:412-741-8967
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001852152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAOEG001852OtherSTATE LICENSE