Provider Demographics
NPI:1750455671
Name:PRESNER, BRUCE (FANO)
Entity Type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:
Last Name:PRESNER
Suffix:
Gender:M
Credentials:FANO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 HEMPSTEAD TPKE
Mailing Address - Street 2:
Mailing Address - City:WEST HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11552-2146
Mailing Address - Country:US
Mailing Address - Phone:516-481-6640
Mailing Address - Fax:516-481-7567
Practice Address - Street 1:126 HEMPSTEAD TPKE
Practice Address - Street 2:
Practice Address - City:WEST HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11552-2146
Practice Address - Country:US
Practice Address - Phone:516-481-6640
Practice Address - Fax:516-481-7567
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4685156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0547610001Medicare NSC