Katrina Renee Lieske, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

5578TG Issued in TX

Practice address

5412 Boat Club Rd Ste 150
Fort Worth, TX 76135-1205

Phone

(817) 546-9000

NPI assigned

Oct 21, 2005

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 identifiers 1

Other names 1

• Dr. Trina Lieske Professional name

Medicare fee-for-service enrollment

Enrolled in TX

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

Specialty

Optometry

Education

University of Houston - College of Optometry, 1998

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Trina Lieske OD PA

  • Optometrist
  • Fort Worth, TX
  • NPI 1609075696
  Medicare reassignment NPD
• Trina Lieske O.D., Fcovd, P.a.

  • Vision Therapy Optometrist
  • Fort Worth, TX
  • NPI 1053974741
  NPD Authorized official

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

{
    "created_epoch": "1129852800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1640649600000",
    "number": "1477542470",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5412 BOAT CLUB RD STE 150",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761351205",
            "telephone_number": "817-546-9000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5412 BOAT CLUB RD STE 150",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761351205",
            "telephone_number": "817-546-9000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIESKE",
        "first_name": "KATRINA",
        "middle_name": "RENEE",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-10-21",
        "last_updated": "2021-12-28",
        "certification_date": "2021-12-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "TX",
            "license": "5578TG",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PROVIDER #",
            "identifier": "0030FG",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TRINA",
            "last_name": "LIESKE",
            "prefix": "DR.",
            "credential": "O.D.",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Marc E. Liebeskind, M.D.
• Meghan Lynn Liebum, NP
• Stephanie Liem, DDS
• Lien Tran Griffin OD PA
• Lindsay E Lientz, LPC
• Janet Lieto, DO
• Kim Lieu
• Thao Lieu
• Gonzalo Lievano, M.D
• Life Spring Health Care Inc

• Optometrist in Fort Worth, TX
• Providers in Fort Worth, TX by specialty
• Optometrist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.