Provider Demographics
NPI:1699183707
Name:HUTCHINSON, BRUCE WILLIS (MD)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:WILLIS
Last Name:HUTCHINSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3707
Mailing Address - Street 2:
Mailing Address - City:OLYMPIC VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:96146-3707
Mailing Address - Country:US
Mailing Address - Phone:530-583-5367
Mailing Address - Fax:
Practice Address - Street 1:143 TIGER TAIL ROAD
Practice Address - Street 2:
Practice Address - City:OLYMPIC VALLEY
Practice Address - State:CA
Practice Address - Zip Code:96146-3707
Practice Address - Country:US
Practice Address - Phone:530-583-5367
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-01
Last Update Date:2014-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG13207207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology