Provider Demographics
NPI:1346201886
Name:BRECKENRIDGE, BRUCE FRANKLIN (OD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:FRANKLIN
Last Name:BRECKENRIDGE
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 1:13140 NE HALSEY ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97230-2350
Mailing Address - Country:US
Mailing Address - Phone:503-253-7278
Mailing Address - Fax:503-253-0279
Practice Address - Street 1:13140 NE HALSEY ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97230-2350
Practice Address - Country:US
Practice Address - Phone:503-253-7278
Practice Address - Fax:503-253-0279
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2070T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR020193Medicaid
OR300365203OtherFIRST CHOICE 65
OR810438003OtherBLUE CROSS
OR810438003OtherBLUE CROSS
U26048Medicare UPIN