Individual provider Active NPI

Jeanny M Liu-Wu, OD

  • Optometrist
  • Saint Paul, MN
National Provider Identifier
1073609715
Registry record updated Dec 20, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
2339 Issued in MN
Practice address
Pearle Vision
3001 White Bear Ave. No., Suite 1050
St. Paul, MN 55109
Phone
(651) 770-3923
Fax
(651) 770-5316
NPI assigned
Oct 4, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 20, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 2339 MN Primary

Addresses

Primary practice location

Pearle Vision
3001 White Bear Ave. No., Suite 1050
St. Paul, MN 55109

Mailing address

3781 Fairway Drive
Woodbury, MN 55125
Phone (651) 735-3477

Other identifiers 3

IdentifierTypeStateIssuer
12342OtherMNEYE MED / COLE VISION
140725200MedicaidMN
3C313WUOtherMNBLUE CROSS BLUE SHIELD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100428000972 MN Practitioner - Optometry 3971630633 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
University of Houston - College of Optometry, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Grace Vision IncGroup PAC ID 8022247998, 4 clinicians

Practice addresses (Care Compare)

3001 White Bear Ave N
Suite 1050
Maplewood, MN 55109-1283
Phone (315) 442-4485

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2339MNMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Grace Vision, Inc. Optometrist CurrentSince Sep 11, 2013 Accepting new patients
Grace Vision, Inc Dba Pearle Vision Current Accepting new patients
Double Image, Inc Past Accepting new patients
Double Image, Inc Past Accepting new patients

Locations

3001 White Bear Ave N
Saint Paul, MN 55109
Phone (651) 770-3923

3001 White Bear Ave N
Ste 1050
Saint Paul, MN 55109
Phone (315) 442-4485

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1159920000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1766188800000",
    "number": "1073609715",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3781 FAIRWAY DRIVE",
            "city": "WOODBURY",
            "state": "MN",
            "postal_code": "55125",
            "telephone_number": "651-735-3477"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "PEARLE VISION",
            "address_2": "3001 WHITE BEAR AVE. NO., SUITE 1050",
            "city": "ST. PAUL",
            "state": "MN",
            "postal_code": "55109",
            "telephone_number": "651-770-3923",
            "fax_number": "651-770-5316"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIU-WU",
        "first_name": "JEANNY",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-10-04",
        "last_updated": "2025-12-20",
        "certification_date": "2025-12-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MN",
            "license": "2339",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EYE MED / COLE VISION",
            "identifier": "12342",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "140725200",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "3C313WU",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Paul, MN

Sources for this page

Verify at the official NPI Registry.