Grace Lisette Rivera, LDO

Primary specialty

OpticianTaxonomy code 156FX1800X

License

002857 Issued in GA

Practice address

351 Alabama Rd
Adel, GA 31620-3818

Phone

(229) 896-9994

Fax

(229) 896-9996

NPI assigned

Apr 24, 2024

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Grace Lisette Rodriguez Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1713916800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713916800000",
    "number": "1043066798",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "351 ALABAMA RD",
            "city": "ADEL",
            "state": "GA",
            "postal_code": "316203818",
            "telephone_number": "229-896-9994",
            "fax_number": "229-896-9996"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "351 ALABAMA RD",
            "city": "ADEL",
            "state": "GA",
            "postal_code": "316203818",
            "telephone_number": "229-896-9994",
            "fax_number": "229-896-9996"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RIVERA",
        "first_name": "GRACE",
        "middle_name": "LISETTE",
        "credential": "LDO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-04-24",
        "last_updated": "2024-04-24",
        "certification_date": "2024-04-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "156FX1800X",
            "taxonomy_group": "",
            "desc": "Technician/Technologist, Optician",
            "state": "GA",
            "license": "002857",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "GRACE",
            "last_name": "RODRIGUEZ",
            "middle_name": "LISETTE",
            "credential": "LDO",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Partners in Health Management, LLC
• Payalkumari Dilipbhai Patel
• Ladonna Shunta Peeples
• Sala Pressley, RPH
• Daniel Blake Purvis, PHARM D
• Melissa Michelle Roberts, FNP-C
• Rodney D. Tyson MD,PC
• Buie Jeffery Rowan, PHARMD
• Lora Emily Schramm, PHARM.D.
• Tim Markam Sellers, O.D.

• All providers in Adel, GA
• Optician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.