Provider Demographics
NPI:1154438471
Name:FLINT, BRUCE G (OD)
Entity type:Individual
Prefix:
First Name:BRUCE
Middle Name:G
Last Name:FLINT
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:PO BOX 1506
Mailing Address - Street 2:
Mailing Address - City:CHEHALIS
Mailing Address - State:WA
Mailing Address - Zip Code:98532-0409
Mailing Address - Country:US
Mailing Address - Phone:360-242-3008
Mailing Address - Fax:360-807-7687
Practice Address - Street 1:6695 W RIO GRANDE AVE
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-3301
Practice Address - Country:US
Practice Address - Phone:509-736-0826
Practice Address - Fax:509-735-6868
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2015-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD00003474152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA410039920OtherRAIL ROAD MEDICARE
WA410039921OtherRAIL ROAD MEDICARE
WA410039922OtherRAIL ROAD MEDICARE
ID410043345OtherRAIL ROAD MEDICARE
ID1591400Medicare PIN
WA410039920OtherRAIL ROAD MEDICARE
T44347Medicare UPIN
WAGAB09004Medicare PIN
WA410039922OtherRAIL ROAD MEDICARE
WAGAB09003Medicare PIN
ID410043345OtherRAIL ROAD MEDICARE
WAGAB09002Medicare PIN