Provider Demographics
NPI:1326037599
Name:HINKLEY, BRUCE ALAN (OD)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:ALAN
Last Name:HINKLEY
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 1:1019 16TH ST
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95354-1105
Mailing Address - Country:US
Mailing Address - Phone:209-526-2737
Mailing Address - Fax:209-338-0151
Practice Address - Street 1:1019 16TH ST
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95354-1105
Practice Address - Country:US
Practice Address - Phone:209-526-2737
Practice Address - Fax:209-338-0074
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-19
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5693T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0056930Medicaid
CA0634290001Medicare NSC
CASD0056930Medicaid
CASD0056930Medicare PIN