DR. JESSICA LYNN BROODRYK (NPI# 1588289474) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1588289474 |
| Entity Type | Individual |
| Full Name | DR. JESSICA LYNN BROODRYK |
| Other Name | JESSICA LYNN BLOMENKAMP |
| Credential | OD |
| Practice Address |
200 Minor Hall Berkeley CA 94720-0001 |
| Practice Telephone | 5106422020 |
| Enumeration Date | 2020-06-16 |
| Last Update Date | 2020-06-16 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 152W00000X | Optometrist | 2020014783 | MO | Eye and Vision Services Providers |
| Street Address |
200 MINOR HALL |
| City | BERKELEY |
| State | CA |
| Zip Code | 94720-0001 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023156965 | John Corzine | Optometrist | 200 Minor Hall, University of California, Berkeley, CA 94720-2020 | 2007-02-02 |
| 1669096384 | Quan Dao | Optometrist | 200 Minor Hall, Berkeley, CA 94720-0001 | 2020-05-29 |
| 1619590924 | Akirta Kour Sran | Optometrist | 200 Minor Hall, Berkeley, CA 94720-0001 | 2020-05-20 |
| 1396390134 | Amrit Bilkhu | Optometrist | 200 Minor Hall, Berkeley, CA 94720-0001 | 2019-08-08 |
| 1356995047 | Cristina Ta | Optometrist | 200 Minor Hall, Berkeley, CA 94720-0001 | 2019-07-31 |
| 1811540198 | Montserrat Joan Astorino | Optometrist | 200 Minor Hall, Berkeley, CA 94720-0001 | 2019-07-16 |
| 1780163808 | Christine Yoo | Optometrist | 200 Minor Hall, Berkeley, CA 94720-0001 | 2018-08-09 |
| 1932654043 | Tara Pahlevan-chaleshtari | Optometrist | 200 Minor Hall, Berkeley, CA 94720 | 2016-08-18 |
| 1255611208 | Carol K Chan | Optometrist | 200 Minor Hall, Berkeley, CA 94720 | 2011-08-23 |
| 1326328790 | Melissa Ann Valdellon | Optometrist | 200 Minor Hall, Berkeley, CA 94720 | 2011-08-17 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609352798 | Richard Phan | Optometrist | 200 Minor Ln, Berkeley, CA 94720 | 2018-07-12 |
| 1184082067 | Carmen Lee | Registered Nurse | 2222 Bancroft Way, Mc4300, Berkeley, CA 94720 | 2016-02-05 |
| 1922355148 | Cynthia Medina | Counselor | 2222 Bancroft Way #4300, Berkeley, CA 94720 | 2012-08-07 |
| 1811199615 | Ellen De Neef | Physical Therapist | 2222 Bancroft, Berkeley, CA 94720 | 2007-06-04 |
| 1427185529 | Margaret Anne Fisher | Nurse Practitioner | 2222 Bancroft Ave, Berkeley, CA 94720 | 2007-02-27 |
| 1619049285 | Vikki V. Yu | Optometrist | 230 Minor Hall, Uc Berkeley School of Optometry, Berkeley, CA 94720 | 2006-11-15 |
| 1801992755 | Robert K Osborne Dds & Assoc Inc | Dentist | 1177 South Main St, North Canton, OH 94720 | 2006-09-16 |
| 1154949899 | Thuy-trang Nguyen | Optometrist | 230 Minor Hall, Berkeley, CA 94720 | 2020-07-09 |
| 1619498656 | Celia R Gong | Optometrist | 230 Minor Hall, Berkeley, CA 94720 | 2017-06-29 |
| 1790234680 | Kelsey Lindquist | Specialist/Technologist | 185 Haas Pavilion, Berkeley, CA 94720 | 2016-10-03 |
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| Taxonomy Code | 152W00000X |
| Grouping | Eye and Vision Services Providers |
| Classification | Optometrist |
| Doctors of optometry (ODs) are the primary health care professionals for the eye. Optometrists examine, diagnose, treat, and manage diseases, injuries, and disorders of the visual system, the eye, and associated structures as well as identify related systemic conditions affecting the eye. An optometrist has completed pre-professional undergraduate education in a college or university and four years of professional education at a college of optometry, leading to the doctor of optometry (O.D.) degree. Some optometrists complete an optional residency in a specific area of practice. Optometrists are eye health care professionals state-licensed to diagnose and treat diseases and disorders of the eye and visual system. |
| Notes: Source: American Optometric Association (AOA), approved by the AOA’s Board of Trustees, June 21, 2005. [7/1/2006: definition modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780208330 | Grace Tseng | Optometrist | 200 Minor Hall University of California At Berkeley, Berkeley, CA 94720-0001 | 2020-05-29 |
| 1194368829 | Yasaman Kahrobaei | Optometrist | 2230 Durant Ave Apt 312, Berkeley, CA 94704-1546 | 2019-10-25 |
| 1194379917 | Yiyi Wang | Optometrist | 230 Minor Hall Berkeley Ca 94720, Berkeley, CA 94720-0001 | 2019-07-30 |
| 1578117404 | Kristi Choy | Optometrist | Uc Berkeley School of Optometry 230 Minor Hall Mc-2020, Berkeley, CA 94720-0001 | 2019-07-29 |
| 1184287641 | Your Two Eyes Optometry Inc. | Optometrist | 2110 Vine St Ste B, Berkeley, CA 94709-1577 | 2019-04-19 |
| 1699254714 | Kenneth Duy Tran | Optometrist | 200 Minor Hall Uc Berkeley School of Optometry, Berkeley, CA 94720-0001 | 2018-08-09 |
| 1609352798 | Richard Phan | Optometrist | 200 Minor Ln, Berkeley, CA 94720 | 2018-07-12 |
| 1972025302 | Crystal T Wang | Optometrist | 200 Minor Lane, Berkeley, CA 94720-2020 | 2017-07-07 |
| 1053867820 | Ying Zhao | Optometrist | 2632 Warring Street #10, Berkeley, CA 94704 | 2016-08-31 |
| 1528441086 | Alfred Vong | Optometrist | 230 Minor Hall Mc 2020, Berkeley, CA 94720-2020 | 2015-07-02 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.