Provider Demographics
NPI:1689653354
Name:PULK, BERNARD JEFFREY (OD)
Entity Type:Individual
Prefix:DR
First Name:BERNARD
Middle Name:JEFFREY
Last Name:PULK
Suffix:
Gender:M
Credentials:OD
Other - Prefix:DR
Other - First Name:B.
Other - Middle Name:JEFFREY
Other - Last Name:PULK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:2025 CASCADE AVE
Mailing Address - Street 2:STE 101
Mailing Address - City:HOOD RIVER
Mailing Address - State:OR
Mailing Address - Zip Code:97031-1272
Mailing Address - Country:US
Mailing Address - Phone:541-386-2402
Mailing Address - Fax:541-308-0293
Practice Address - Street 1:301 CHERRY HEIGHTS RD
Practice Address - Street 2:
Practice Address - City:THE DALLES
Practice Address - State:OR
Practice Address - Zip Code:97058-3586
Practice Address - Country:US
Practice Address - Phone:541-296-1101
Practice Address - Fax:541-298-1538
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAT3526152WC0802X, 152WP0200X, 152WS0006X, 152WX0102X, 152W00000X
156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WS0006XEye and Vision Services ProvidersOptometristSports Vision
No152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1689653354Medicaid
MI4351130Medicaid
MI0C97655078Medicare PIN
MI0N57570Medicare PIN