Individual provider Active NPI

Grace Liao

  • Optometrist
  • Glendale, AZ
National Provider Identifier
1699127225
Registry record updated Sep 19, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
2222 Issued in AZ
Practice address
5865 W Utopia Rd
Glendale, AZ 85308
Phone
(623) 806-7214
Fax
(623) 806-7210
NPI assigned
Jul 7, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 19, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 2222 AZ Primary

Addresses

Primary practice location

5865 W Utopia Rd
Glendale, AZ 85308

Mailing address

5865 W Utopia Rd
Glendale, AZ 85308-5251

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA, AZ2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20160831002981 CA Practitioner - Optometry 6800182700 Reassigns benefits to 1 organization
I20171206000123 AZ Practitioner - Optometry 6800182700 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Southern California College of Optometry, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Midwestern UniversityGroup PAC ID 6305734773, 116 clinicians

Practice addresses (Care Compare)

5865 W Utopia Rd
Glendale, AZ 85308-5251
Phone (623) 537-6000

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2222AZMDDentist
33445CAMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Midwestern University Optometrist CurrentSince Nov 1, 2017 Accepting new patients
Marshall B. Ketchum University CurrentSince Jun 29, 2016 Accepting new patients
Midwestern University Optometrist CurrentSince Nov 1, 2017 Accepting new patients
Marshall B. Ketchum University Optometrist CurrentSince Jun 29, 2016 Accepting new patients

Locations

5865 W Utopia Rd
Glendale, AZ 85308
Phone (623) 806-7200

19389 N 59th Ave
Glendale, AZ 85308

5460 E La Palma Ave
Anaheim, CA 92807
Phone (714) 463-7500

26520 Network Pl
Chicago, IL 60673
Phone (630) 743-4500

Interoperability endpoints

  • Direct secure messaging: gliao18526@direct.midwestern.edu
  • Direct secure messaging: grace.liao.p3@direct.midwesternuniversity.nextgenshare.com
  • FHIR API: https://fhir.meditouchehr.com/api/fhir/r4/

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": "1467849600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1537315200000",
    "number": "1699127225",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5865 W UTOPIA RD",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853085251",
            "fax_number": "623-806-7210"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5865 W UTOPIA RD",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "85308",
            "telephone_number": "623-806-7214",
            "fax_number": "623-806-7210"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIAO",
        "first_name": "GRACE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-07-07",
        "last_updated": "2018-09-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "AZ",
            "license": "2222",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Glendale, AZ

Sources for this page

Verify at the official NPI Registry.