Provider Demographics
NPI:1255327854
Name:BLEILER, BRIAN EUGENE (OD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:EUGENE
Last Name:BLEILER
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 1:207 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:ELMIRA
Mailing Address - State:NY
Mailing Address - Zip Code:14901-3204
Mailing Address - Country:US
Mailing Address - Phone:607-734-2984
Mailing Address - Fax:607-398-3411
Practice Address - Street 1:406 E 4TH ST
Practice Address - Street 2:
Practice Address - City:WATKINS GLEN
Practice Address - State:NY
Practice Address - Zip Code:14891-1217
Practice Address - Country:US
Practice Address - Phone:607-535-4842
Practice Address - Fax:607-398-3413
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYVUT005098152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
410020897OtherRR MEDICARE
410020897OtherRR MEDICARE