Healthcare Provider Details

I. General information

NPI: 1801883954
Provider Name (Legal Business Name): JOSEPH C TRULL OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2005
Last Update Date: 11/27/2024
Certification Date: 11/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1135 BETHEL AVE
PORT ORCHARD WA
98366-3125
US

IV. Provider business mailing address

1135 BETHEL AVE
PORT ORCHARD WA
98366-3125
US

V. Phone/Fax

Practice location:
  • Phone: 360-895-2020
  • Fax: 360-874-0048
Mailing address:
  • Phone: 360-895-2020
  • Fax: 360-874-0048

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOD00002086
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: