Bradley Kyle Nielson, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

3519WA Issued in WA

Practice address

2316 Eastgate St Ste 170
Walla Walla, WA 99362-1576

Phone

(509) 529-7371

NPI assigned

Aug 14, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

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

Specialty

Optometry

Education

Pacific University - College of Optometry, 1999

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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

• Nielson Eye Care

  • Optometrist
  • Walla Walla, WA
  • NPI 1922366327
  Medicare reassignment NPD Authorized official
• Shopko Stores Operating Co. LLC

  • Eyewear Supplier
  • Walla Walla, WA
  • NPI 1902859531

  Optometrist

  NPD (past)
• Shopko Properties, LLC

  • Eyewear Supplier
  • Green Bay, WI
  • NPI 1518086099
  NPD (past)
• Shopko Stores Operating Co. LLC

  • Eyewear Supplier
  • Albert Lea, MN
  • NPI 1528010642
  NPD (past)

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

{
    "created_epoch": "1155513600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1766016000000",
    "number": "1891708616",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2316 EASTGATE ST STE 170",
            "city": "WALLA WALLA",
            "state": "WA",
            "postal_code": "993621576",
            "telephone_number": "509-529-7371"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2316 EASTGATE ST STE 170",
            "city": "WALLA WALLA",
            "state": "WA",
            "postal_code": "993621576",
            "telephone_number": "509-529-7371"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NIELSON",
        "first_name": "BRADLEY",
        "middle_name": "KYLE",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-14",
        "last_updated": "2025-12-18",
        "certification_date": "2025-12-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WA",
            "license": "3519WA",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2130268WA",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2017328",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Benjamin Nichols
• Jazmin Nichols
• Danelle Nick, MD
• Nielson Eye Care
• Amy L Nielson, LSWAIC
• Trudee Kaye Nims, R.D.
• Fnu Nisina
• Juliet Chinwe Nnaji, RN
• Robin E Noble
• Patricia Noel, OTR

• Optometrist in Walla Walla, WA
• Providers in Walla Walla, WA by specialty
• Optometrist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.