MEDICARE: JESSICA VALACHOVIC BRETNALL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	OPC6245	FL

General Provider Information

NPI Number	:	1174208003
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA VALACHOVIC BRETNALL

Provider Business Mailing Address
First Line	:	8516 SHALLOW CREEK CT
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34653-7025
Country	:	US
Telephone Number	:	727-385-1789
Fax Number	:

Provider Business Practice Location Address
First Line	:	9409 US HIGHWAY 19 STE 336
Second Line	:
City	:	PORT RICHEY
State	:	FL
Zip	:	34668-4632
Country	:	US
Telephone Number	:	727-845-5506
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/19/2023
Last Update Date	:	12/12/2025

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Directions to “ JESSICA VALACHOVIC BRETNALL ” Practice Location

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