Individual provider Active NPI

Jennifer M Liao, OD

  • Optometrist
  • Boston, MA
National Provider Identifier
1144644147
Registry record updated Apr 19, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
4987 Issued in MA
Practice address
930 Commonwealth Ave
Suite 2a
Boston, MA 02215-1274
Phone
(617) 262-2020
NPI assigned
Feb 11, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 19, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 4987 MA Primary

Addresses

Primary practice location

930 Commonwealth Ave
Suite 2a
Boston, MA 02215-1274

Mailing address

63 Brentwood St
Allston, MA 02134-1302
Phone (617) 388-3751

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
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
I20190515001484 MA Practitioner - Optometry 4587907522 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
New England College of Optometry, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
New England Eye Institute IncGroup PAC ID 1850294125, 23 clinicians

Practice addresses (Care Compare)

930 Commonwealth Ave
Boston, MA 02215-1220
Phone (617) 262-2020

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
4987MAMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
New England Eye Institute Inc. Optometrist CurrentSince May 1, 2019 Accepting new patients

Locations

930 Commonwealth Ave
Ste 2A
Boston, MA 02215
Phone (617) 262-2020

930 Commonwealth Ave
Boston, MA 02215
Phone (617) 262-2020

Organizations & group practices 1

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": "1392076800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1555632000000",
    "number": "1144644147",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "63 BRENTWOOD ST",
            "city": "ALLSTON",
            "state": "MA",
            "postal_code": "021341302",
            "telephone_number": "617-388-3751"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "930 COMMONWEALTH AVE",
            "address_2": "SUITE 2A",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "022151274",
            "telephone_number": "617-262-2020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIAO",
        "first_name": "JENNIFER",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-02-11",
        "last_updated": "2019-04-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MA",
            "license": "4987",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boston, MA

Sources for this page

Verify at the official NPI Registry.