Provider Demographics
NPI:1699854539
Name:PARSONS, BRUCE C (OD PC)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:C
Last Name:PARSONS
Suffix:
Gender:M
Credentials:OD PC
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 190
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OR
Mailing Address - Zip Code:97391-0190
Mailing Address - Country:US
Mailing Address - Phone:541-336-3211
Mailing Address - Fax:541-336-3043
Practice Address - Street 1:680 W HIGHWAY 20
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OR
Practice Address - Zip Code:97391-0190
Practice Address - Country:US
Practice Address - Phone:541-336-3211
Practice Address - Fax:541-336-3043
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2010-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR955AT1 ACTIVE152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR147637Medicaid
OR0690830001Medicare NSC
OR0000PGBZKMedicare PIN
ORT67990Medicare UPIN