Lisa Wadolowski Koehler, OD
Individual provider Active NPI Optometrist · Memphis, TN
NPI 1164094702 · NPPES record last updated Nov 1, 2024
Key facts
- NPI
- 1164094702
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 009354 (NY)
- Practice address
- 1225 Madison Ave
Memphis, TN 38104-2211 - Phone
- (901) 722-3250
- NPI assigned
- Jul 13, 2021
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Optometry
- Education
- Other, 2021
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Southern College of Optometry
Practice addresses (Care Compare)
1245 Madison Ave
Memphis, TN 38104-2211
Phone (901) 722-3385
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20211025000860 | TN | Practitioner - Optometry | 8729476718 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3703 | TN | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Southern College of Optometry | Optometrist | Current |
Accepting new patients |
| Southern College of Optometry | Optometrist | Past |
Accepting new patients |
Locations
1245 Madison Ave
Memphis, TN 38104
Phone (901) 722-3250
1225 Madison Ave
Memphis, TN 38104
Phone (901) 722-3250
212 Rawlins Service Ct
Memphis, TN 38152
Phone (901) 252-3697
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 009354 | NY | Yes |
Addresses
Primary practice location
1225 Madison Ave
Memphis, TN 38104-2211
Mailing address
1245 Madison Ave
Memphis, TN 38104-2211
Other providers in Memphis, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 1, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.