Provider Demographics
NPI:1801883954
Name:TRULL, JOSEPH C (OD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:C
Last Name:TRULL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1135 BETHEL AVE
Mailing Address - Street 2:
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98366-3125
Mailing Address - Country:US
Mailing Address - Phone:360-895-2020
Mailing Address - Fax:360-874-0048
Practice Address - Street 1:1135 BETHEL AVE
Practice Address - Street 2:
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98366-3125
Practice Address - Country:US
Practice Address - Phone:360-895-2020
Practice Address - Fax:360-874-0048
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2024-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD00002086152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2023547Medicaid
WA2023547Medicaid
WAAB28141Medicare ID - Type Unspecified