Individual provider Active NPI

Jessica Valachovic Bretnall

  • Optometrist
  • Port Richey, FL
National Provider Identifier
1174208003
Registry record updated Dec 12, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OPC6245 Issued in FL
Practice address
9409 US Highway 19 Ste 336
Port Richey, FL 34668-4632
Phone
(727) 845-5506
NPI assigned
Jun 19, 2023
Last updated
Dec 12, 2025By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 12, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X OPC6245 FL Primary

Addresses

Primary practice location

9409 US Highway 19 Ste 336
Port Richey, FL 34668-4632

Mailing address

8516 Shallow Creek CT
New Port Richey, FL 34653-7025
Phone (727) 385-1789

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230823001680 FL Practitioner - Optometry 8224491394 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
John L. Meyers, OD PAGroup PAC ID 2668495532, 5 clinicians

Practice addresses (Care Compare)

23902 US Hwy 19 N
Clearwater, FL 33765-1563
Phone (727) 726-3133

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery12

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1687132800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1765497600000",
    "number": "1174208003",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8516 SHALLOW CREEK CT",
            "city": "NEW PORT RICHEY",
            "state": "FL",
            "postal_code": "346537025",
            "telephone_number": "727-385-1789"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9409 US HIGHWAY 19 STE 336",
            "city": "PORT RICHEY",
            "state": "FL",
            "postal_code": "346684632",
            "telephone_number": "727-845-5506"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRETNALL",
        "first_name": "JESSICA",
        "middle_name": "VALACHOVIC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-06-19",
        "last_updated": "2025-12-12",
        "certification_date": "2025-12-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "FL",
            "license": "OPC6245",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Richey, FL

Sources for this page

Verify at the official NPI Registry.