Meron Fantahun, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

OPT003464 Issued in GA

Practice address

4153 Lawrenceville Hwy NW Ste 5
Lilburn, GA 30047-2854

Phone

(770) 921-4707

NPI assigned

Aug 26, 2022

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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

Specialty

Optometry

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Clarkson Optometry Georgia Inc 14 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://app.meldrx.com/api/fhir/ecp_cecga

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.

• Clarkson Optometry Georgia Inc

  • Optometrist
  • Alpharetta, GA
  • NPI 1184802670

  GA, Optometrist

  Medicare reassignment Care Compare group NPD
• Clarkson Optometry Georgia Inc

  • Optometrist
  • Braselton, GA
  • NPI 1811087208
  NPD (past)
• State of Mississippi - University of Mississippi Medical Center

  • Critical Access Hospital
  • Lexington, MS
  • NPI 1386630705
  NPD (past)

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

{
    "created_epoch": "1661472000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663372800000",
    "number": "1245959683",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 207173",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "753207173",
            "telephone_number": "636-200-4393",
            "fax_number": "636-527-0766"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4153 LAWRENCEVILLE HWY NW STE 5",
            "city": "LILBURN",
            "state": "GA",
            "postal_code": "300472854",
            "telephone_number": "770-921-4707"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "181 Beaverwood Ct",
            "address_purpose": "LOCATION",
            "city": "Lawrenceville",
            "state": "GA",
            "postal_code": "300444177",
            "country_code": "US",
            "telephone_number": "404-387-2366",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4320 Suwanee Dam Rd Ste 2100",
            "address_purpose": "LOCATION",
            "city": "Suwanee",
            "state": "GA",
            "postal_code": "300241949",
            "country_code": "US",
            "telephone_number": "770-614-8577",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5777 Old Winder Hwy",
            "address_purpose": "LOCATION",
            "city": "Braselton",
            "state": "GA",
            "postal_code": "305171603",
            "country_code": "US",
            "telephone_number": "770-534-5305",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1675 Cumberland Pkwy SE Ste 103",
            "address_purpose": "LOCATION",
            "city": "Smyrna",
            "state": "GA",
            "postal_code": "300806360",
            "country_code": "US",
            "telephone_number": "770-438-0202",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2427 Heritage Vlg Ste 4",
            "address_purpose": "LOCATION",
            "city": "Snellville",
            "state": "GA",
            "postal_code": "300782699",
            "country_code": "US",
            "telephone_number": "770-978-2020",
            "fax_number": "470-508-2002",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1013 E Freeway Dr SE",
            "address_purpose": "LOCATION",
            "city": "Conyers",
            "state": "GA",
            "postal_code": "300945965",
            "country_code": "US",
            "telephone_number": "770-922-7906",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3820 Pleasant Hill Rd Ste 5",
            "address_purpose": "LOCATION",
            "city": "Duluth",
            "state": "GA",
            "postal_code": "300961429",
            "country_code": "US",
            "telephone_number": "770-476-9585",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FANTAHUN",
        "first_name": "MERON",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-08-26",
        "last_updated": "2022-09-17",
        "certification_date": "2022-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "GA",
            "license": "OPT003464",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• All providers in Lilburn, GA
• Optometrist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2022; 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.