Marysville Vision Source PC

Primary specialty

OptometristTaxonomy code 152W00000X

License

OD60304885 Issued in WA

Legal business name

MARYSVILLE VISION SOURCE PC

Practice address

1098 Alder Ave
Marysville, WA 98270-4318

Phone

(360) 659-6255

Fax

(360) 653-2466

NPI assigned

Aug 6, 2016

Organization subpart

No

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

Authorized official

Name

Dr. Jessie Li-Wei Liu, O.D.

Title

Optometric Physician/Owner

Phone

(360) 659-6255

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1470441600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1476835200000",
    "number": "1154875219",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1098 ALDER AVE",
            "city": "MARYSVILLE",
            "state": "WA",
            "postal_code": "982704318",
            "telephone_number": "360-659-6255",
            "fax_number": "360-653-2466"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1098 ALDER AVE",
            "city": "MARYSVILLE",
            "state": "WA",
            "postal_code": "982704318",
            "telephone_number": "360-659-6255",
            "fax_number": "360-653-2466"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARYSVILLE VISION SOURCE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-08-06",
        "last_updated": "2016-10-19",
        "status": "A",
        "authorized_official_last_name": "LIU",
        "authorized_official_first_name": "JESSIE",
        "authorized_official_middle_name": "LI-WEI",
        "authorized_official_title_or_position": "OPTOMETRIC PHYSICIAN/OWNER",
        "authorized_official_telephone_number": "360-659-6255",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "WA",
            "license": "OD60304885",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Optometrist in Marysville, WA
• Providers in Marysville, WA by specialty
• Optometrist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2016; 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.