Carole F Medou, LDO

Primary specialty

OpticianTaxonomy code 156FX1800X

License

2211 Issued in GA

Practice address

57 Hurricane Shoals Rd NW Ste a
Lawrenceville, GA 30046-5396

Phone

(678) 878-3540

NPI assigned

Jul 28, 2020

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Medizen Transit Services LLC

  • Non-emergency Medical Transport (VAN)
  • Lawrenceville, GA
  • NPI 1760274724
  NPD (past) Authorized official

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

{
    "created_epoch": "1595894400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1595894400000",
    "number": "1427667302",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1475 BUFORD DR",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300433719",
            "telephone_number": "470-535-8540"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "57 HURRICANE SHOALS RD NW STE A",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300465396",
            "telephone_number": "678-878-3540"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEDOU",
        "first_name": "CAROLE",
        "middle_name": "F",
        "name_prefix": "Mrs.",
        "credential": "LDO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-07-28",
        "last_updated": "2020-07-28",
        "certification_date": "2020-07-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "156FX1800X",
            "taxonomy_group": "",
            "desc": "Technician/Technologist, Optician",
            "state": "GA",
            "license": "2211",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PEACHSTATE, WELLCARE, MEDICAID, CARESOURCE",
            "identifier": "752180024",
            "state": "GA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "other",
            "affiliation": "N",
            "endpointDescription": "other",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "other",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "other",
            "address_1": "30 stonebrok pl",
            "city": "lawrenceville",
            "state": "GA",
            "country_code": "US",
            "postal_code": "30043",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "google",
            "affiliation": "N",
            "endpointDescription": "google",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "57 Hurricane Shoals Rd NW Ste A",
            "city": "Lawrenceville",
            "state": "GA",
            "country_code": "US",
            "postal_code": "300465396",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Medigator LLC
• Mediloop Inc
• Amsi Medina, DO
• Medizen Transit Services LLC
• Medlink Georgia Inc
• Medpro Wound Care Services LLC
• Medquip LLC
• Medway Air Ambulance LLC
• Michael Anthony Meehan
• Joan Meeks, RN

• Optician in Lawrenceville, GA
• Providers in Lawrenceville, GA by specialty
• Optician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.