Provider Demographics
NPI:1679592190
Name:BIRCUMSHAW, HAROLD L (OD)
Entity Type:Individual
Prefix:DR
First Name:HAROLD
Middle Name:L
Last Name:BIRCUMSHAW
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 1:4620 PACIFIC AVE
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98408-7738
Mailing Address - Country:US
Mailing Address - Phone:253-473-3443
Mailing Address - Fax:253-473-7127
Practice Address - Street 1:4620 PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98408-7738
Practice Address - Country:US
Practice Address - Phone:253-473-3443
Practice Address - Fax:253-473-7127
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1349152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAWA0179OtherNBN
WA482,107-02OtherL & I WORKERS COMP
WA1203680OtherDSHS VENDOR
WAG8878811OtherMEDICARE PTAN
WA209-783OtherOFFICE OF DISABILITY INSURANCE
WA2264OtherDAVIS VISION
WA4595135OtherEPDB
WA61722OtherSPECTERA
WABI 0008OtherREGENCE BLUE SHIELD
WA61722OtherSPECTERA
WA4088720001Medicare NSC
WATO 2664Medicare UPIN