NPIMap

Organization Active NPI

Bridgeport Family Vision Clinic, PLLC

  • Optometrist
  • Lakewood, WA
National Provider Identifier
1235517541
Registry record updated Apr 4, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OD1574 Issued in WA
Legal business name
BRIDGEPORT FAMILY VISION CLINIC, PLLC
Practice address
9101 Bridgeport Way SW
Suite C
Lakewood, WA 98499-2419
Phone
(253) 584-2020
Fax
(253) 588-0545
NPI assigned
May 7, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 4, 2025

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

Authorized official

Name
Dr. Amrit L Jawanda, O.D.
Title
OD, Owner
Phone
(535) 880-5452

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X OD1574 WA Primary

Addresses

Primary practice location

9101 Bridgeport Way SW
Suite C
Lakewood, WA 98499-2419

Mailing address

9101 Bridgeport Way SW
Suite C
Lakewood, WA 98499-2419
Phone (253) 588-2254

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150915000703 WA Part B Supplier - Clinic/Group Practice 6901113596 Receives reassigned benefits from 9 practitioners
Practice locations: Lakewood, WA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1430956800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1743724800000",
    "number": "1235517541",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9101 BRIDGEPORT WAY SW",
            "address_2": "SUITE C",
            "city": "LAKEWOOD",
            "state": "WA",
            "postal_code": "984992419",
            "telephone_number": "253-588-2254",
            "fax_number": "253-588-0545"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9101 BRIDGEPORT WAY SW",
            "address_2": "SUITE C",
            "city": "LAKEWOOD",
            "state": "WA",
            "postal_code": "984992419",
            "telephone_number": "253-584-2020",
            "fax_number": "253-588-0545"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRIDGEPORT FAMILY VISION CLINIC, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-05-07",
        "last_updated": "2025-04-04",
        "certification_date": "2025-03-27",
        "status": "A",
        "authorized_official_last_name": "JAWANDA",
        "authorized_official_first_name": "AMRIT",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OD, OWNER",
        "authorized_official_telephone_number": "535-880-5452",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "WA",
            "license": "OD1574",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lakewood, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.