Lucille Hester Brongersma, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

8200T Issued in CA

Practice address

3925 Old Redwood Hwy
Santa Rosa, CA 95403-1719

Phone

(707) 566-5297

NPI assigned

Jan 3, 2007

Last updated

Dec 30, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1167782400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1640822400000",
    "number": "1033266218",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4844 GLENCANNON ST",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954057912",
            "telephone_number": "707-538-2482"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3925 OLD REDWOOD HWY",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954031719",
            "telephone_number": "707-566-5297"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRONGERSMA",
        "first_name": "LUCILLE",
        "middle_name": "HESTER",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-03",
        "last_updated": "2021-12-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "8200T",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ncalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "The Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "3925 Old Redwood Hwy",
            "city": "Santa Rosa",
            "state": "CA",
            "country_code": "US",
            "postal_code": "954031719",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Danna Maria Brock, CNP
• Rosemary Brock, MFT
• Jeffery Broffman, M.D.
• Robert Paul Brohmer, LMFT
• George William Bromley Jr., MFT INTERN
• Tessa Bronner
• Lorien Bronsert, RADT1
• Jina Christine Brooks, MFT
• Marilyn R Brooks
• Brookwood Anesthesia Inc

• Optometrist in Santa Rosa, CA
• Providers in Santa Rosa, CA by specialty
• Optometrist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.