Provider Demographics
NPI:1417687633
Name:BRESNAHAN, CADEN TYLER
Entity Type:Individual
Prefix:
First Name:CADEN
Middle Name:TYLER
Last Name:BRESNAHAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 US HIGHWAY 27 S
Mailing Address - Street 2:
Mailing Address - City:CYNTHIANA
Mailing Address - State:KY
Mailing Address - Zip Code:41031-6888
Mailing Address - Country:US
Mailing Address - Phone:859-234-6190
Mailing Address - Fax:859-234-3067
Practice Address - Street 1:805 US HIGHWAY 27 S
Practice Address - Street 2:
Practice Address - City:CYNTHIANA
Practice Address - State:KY
Practice Address - Zip Code:41031-6888
Practice Address - Country:US
Practice Address - Phone:859-234-6190
Practice Address - Fax:859-234-3067
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-11
Last Update Date:2022-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY271866156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician