Healthcare Provider Details

I. General information

NPI: 1871417667
Provider Name (Legal Business Name): GLASS MERIDIAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4425 S MOPAC EXPY STE 502
AUSTIN TX
78735-6725
US

IV. Provider business mailing address

1901 ONION CREEK PKWY APT 3104
AUSTIN TX
78748-1970
US

V. Phone/Fax

Practice location:
  • Phone: 631-521-9745
  • Fax:
Mailing address:
  • Phone: 631-521-9745
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: JESSICA GLASS
Title or Position: LICENSED ACUPUNCTURIST
Credential: L.AC, LMT
Phone: 631-521-9745