Individual provider Active NPI

Wenshan Liu, OD

  • Optometrist
  • Bend, OR
National Provider Identifier
1295162642
Registry record updated Jan 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
14754 Issued in CA
Practice address
62968 O B Riley Rd
Bend, OR 97703-9442
Phone
(541) 382-2020
NPI assigned
Oct 1, 2013
Last updated
Jan 17, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 17, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 4588 OR
Optometrist 152W00000X 14754 CA Primary

Addresses

Primary practice location

62968 O B Riley Rd
Bend, OR 97703-9442

Mailing address

15051 Hesperian Blvd Ste a
San Leandro, CA 94578-3536
Phone (510) 276-1212

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20151204000592 CA Practitioner - Optometry 2062712573 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
4588ORMDOptometrist
14754CAMDPediatric Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Danville-San Ramon Eye Medical Corp CurrentSince Nov 1, 2015 Accepting new patients
Dr Eric T Brooker PC Optometrist Past Accepting new patients

Locations

909 San Ramon Valley Blvd
Ste 114
Danville, CA 94526
Phone (925) 837-5922

Interoperability endpoints

  • Direct secure messaging: wliu@batravision.direct.eyemdemr.com

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1380585600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1737072000000",
    "number": "1295162642",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15051 HESPERIAN BLVD STE A",
            "city": "SAN LEANDRO",
            "state": "CA",
            "postal_code": "945783536",
            "telephone_number": "510-276-1212"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "62968 O B RILEY RD",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977039442",
            "telephone_number": "541-382-2020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIU",
        "first_name": "WENSHAN",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-10-01",
        "last_updated": "2025-01-17",
        "certification_date": "2025-01-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "OR",
            "license": "4588",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "14754",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bend, OR

Sources for this page

Verify at the official NPI Registry.