Carly Jean Kiomall, OD, MPH

Primary specialty

OptometristTaxonomy code 152W00000X

License

OEG003398 Issued in PA

Practice address

11690 Alpharetta Hwy
Roswell, GA 30076-3805

Phone

(770) 475-5515

NPI assigned

Jun 28, 2017

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 4

Addresses

Other names 1

• Dr. Carly Jean Grondin Former name

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in GA

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: cjkiomall@teg.emadirect.md

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.

• Myeyedr Optometry of Georgia, LLC

  • Optometrist
  • Rincon, GA
  • NPI 1437294592

  GA, Optometrist

  Medicare reassignment NPD
• Thomas Eye Group PC

  • Ophthalmology Physician
  • Sandy Springs, GA
  • NPI 1548271992

  GA, Optometrist

  Medicare reassignment NPD
• Myeyedr Optometry of Georgia LLC

  • Optometrist
  • Canton, GA
  • NPI 1972136224
  NPD
• Myeyedr Optometry of Georgia, LLC

  • Optometrist
  • Tyrone, GA
  • NPI 1275326571
  NPD
• Thomas Eye Group PC

  • Optometrist
  • Stone Mountain, GA
  • NPI 1043032840
  NPD
• Thomas Eye Group PC

  • Ophthalmology Physician
  • Peachtree City, GA
  • NPI 1437812625

  Single Specialty

  NPD
• Thomas Eye Group PC

  • Ophthalmology Physician
  • Woodstock, GA
  • NPI 1215047683

  Single Specialty

  NPD (past)
• Children'S Surgical Associates LTD

  • Urology Physician
  • Philadelphia, PA
  • NPI 1003985854

  Single Specialty

  NPD (past)
• Children'S Surgical Associates LTD

  • Neurological Surgery Physician
  • Philadelphia, PA
  • NPI 1821177395
  NPD (past)

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

{
    "created_epoch": "1498608000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1634256000000",
    "number": "1124549332",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5901 PEACHTREE DUNWOODY RD STE A500",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303287162",
            "telephone_number": "678-781-7373"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11690 ALPHARETTA HWY",
            "city": "ROSWELL",
            "state": "GA",
            "postal_code": "300763805",
            "telephone_number": "770-475-5515"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1409 Sixes Rd",
            "address_purpose": "LOCATION",
            "city": "Canton",
            "state": "GA",
            "postal_code": "301148950",
            "country_code": "US",
            "telephone_number": "770-852-2733",
            "fax_number": "678-394-9948",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KIOMALL",
        "first_name": "CARLY",
        "middle_name": "JEAN",
        "name_prefix": "Dr.",
        "credential": "OD, MPH",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-06-28",
        "last_updated": "2021-10-15",
        "certification_date": "2021-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "GA",
            "license": "OPT003301",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NJ",
            "license": "27OA00684900",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NY",
            "license": "008634",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "PA",
            "license": "OEG003398",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "cjkiomall@teg.emadirect.md",
            "affiliation": "N",
            "endpointDescription": "Direct Email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "11690 Alpharetta Hwy",
            "city": "Roswell",
            "state": "GA",
            "country_code": "US",
            "postal_code": "300763805",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "CARLY",
            "last_name": "GRONDIN",
            "middle_name": "JEAN",
            "prefix": "DR.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Kathy Leigh King, M.ED., CCC-SLP
• Megan King
• Valerie Yuhr King, M.A., CCC-SLP
• Lydia J Kinkead, D.C,
• Brittany Kinser, NP
• Karen Kipley, BCBA
• Charles Edward Kirby, D.M.D.
• Claire Kirkland
• Delores K. Kirkpatrick, M.D.
• Joseph Franklin Kirkpatrick, LPC

• All providers in Roswell, GA
• Optometrist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.