Provider Demographics
NPI:1275504524
Name:LENSER, BRIAN ALEXANDER (MD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:ALEXANDER
Last Name:LENSER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 576644
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95357-6644
Mailing Address - Country:US
Mailing Address - Phone:209-572-8528
Mailing Address - Fax:209-572-8530
Practice Address - Street 1:3109 COFFEE RD
Practice Address - Street 2:STE C
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-1766
Practice Address - Country:US
Practice Address - Phone:209-572-8528
Practice Address - Fax:209-572-8530
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-26
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG75079207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G750791Medicaid
CAG06885Medicare UPIN
CA00G750790Medicare ID - Type Unspecified