Provider Demographics
NPI:1346242997
Name:BRUMLEY, ROBERT HUGH (OD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:HUGH
Last Name:BRUMLEY
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 1:6420 S MACADAM AVE STE 160
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-3517
Mailing Address - Country:US
Mailing Address - Phone:503-244-8601
Mailing Address - Fax:503-244-3013
Practice Address - Street 1:18345 SW ALEXANDER ST
Practice Address - Street 2:SUITE A
Practice Address - City:ALOHA
Practice Address - State:OR
Practice Address - Zip Code:97006-3960
Practice Address - Country:US
Practice Address - Phone:503-642-2505
Practice Address - Fax:503-649-9556
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1337T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR226344Medicaid
ORT02504Medicare UPIN
OR107296Medicare PIN