Individual provider Active NPI

Jessica Lynn Wilson Trondsen, OD

  • Optometrist
  • Bremerton, WA
National Provider Identifier
1720570054
Registry record updated Jul 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OD60861861 Issued in WA
Practice address
1 Boone Rd
Bremerton, WA 98312-1898
Phone
(360) 476-7058
Fax
(360) 476-2480
NPI assigned
Jun 1, 2018
Last updated
Jul 22, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 22, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X OD60861861 WA Primary

Addresses

Primary practice location

1 Boone Rd
Bremerton, WA 98312-1898

Mailing address

1400 Farragut Ave BLDG 940
Bremerton, WA 98314-6001
Phone (360) 476-7058

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
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
I20181029000292 WA Practitioner - Optometry 4880947423 Reassigns benefits to 3 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Kingston Eyecare Center, LLC Optometrist CurrentSince Aug 5, 2018 Accepting new patients
Port Orchard Eyecare Centers Inc, PS Optometrist CurrentSince Aug 5, 2018 Accepting new patients
Silverdale Eyecare Center Inc Optometrist CurrentSince Aug 5, 2018 Accepting new patients
Branch Medical Clinic Puget Sound PastSince Jul 25, 2021 Accepting new patients

Locations

25989 Barber Cut Off Rd NE
Kingston, WA 98346
Phone (360) 297-2844

2914 Mitchell Rd SE
Port Orchard, WA 98366
Phone (360) 784-2020

3647 NW Byron St
Silverdale, WA 98383
Phone (360) 692-6115

3647 NW Byron St
Ste 100
Silverdale, WA 98383
Phone (360) 692-6115

Organizations & group practices 4

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": "1527811200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626912000000",
    "number": "1720570054",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 FARRAGUT AVE BLDG 940",
            "city": "BREMERTON",
            "state": "WA",
            "postal_code": "983146001",
            "telephone_number": "360-476-7058",
            "fax_number": "360-476-2480"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 BOONE RD",
            "city": "BREMERTON",
            "state": "WA",
            "postal_code": "983121898",
            "telephone_number": "360-476-7058",
            "fax_number": "360-476-2480"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TRONDSEN",
        "first_name": "JESSICA",
        "middle_name": "LYNN WILSON",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-06-01",
        "last_updated": "2021-07-22",
        "certification_date": "2021-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WA",
            "license": "OD60861861",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bremerton, WA

Sources for this page

Verify at the official NPI Registry.