Healthcare Provider Details

I. General information

NPI: 1346242997
Provider Name (Legal Business Name): ROBERT HUGH BRUMLEY OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2005
Last Update Date: 08/13/2020
Certification Date: 08/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18345 SW ALEXANDER ST SUITE A
ALOHA OR
97006-3960
US

IV. Provider business mailing address

6420 S MACADAM AVE STE 160
PORTLAND OR
97239-3517
US

V. Phone/Fax

Practice location:
  • Phone: 503-642-2505
  • Fax: 503-649-9556
Mailing address:
  • Phone: 503-244-8601
  • Fax: 503-244-3013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1337T
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: