Diane Shahara Jamoua, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

4901004760 Issued in MI

Practice address

4555 Wilson Ave SW
Grandville, MI 49418-2370

Phone

(616) 249-8490

Fax

(616) 249-3129

NPI assigned

Jun 27, 2013

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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MI

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

Practice roles

Locations

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 Michigan, LLC

  • Optometrist
  • Shelby Township, MI
  • NPI 1639723596
  Medicare reassignment NPD
• Myeyedr Optometry of Michigan, LLC

  • Optometrist
  • Clarkston, MI
  • NPI 1215753553
  NPD
• Myeyedr Optometry of Michigan, LLC

  • Optometrist
  • Grandville, MI
  • NPI 1740865237
  NPD

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

{
    "created_epoch": "1372291200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1619481600000",
    "number": "1740620376",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1950 OLD GALLOWS RD STE 520",
            "city": "VIENNA",
            "state": "VA",
            "postal_code": "221823970",
            "telephone_number": "703-847-8899",
            "fax_number": "571-223-6780"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4555 WILSON AVE SW",
            "city": "GRANDVILLE",
            "state": "MI",
            "postal_code": "494182370",
            "telephone_number": "616-249-8490",
            "fax_number": "616-249-3129"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JAMOUA",
        "first_name": "DIANE",
        "middle_name": "SHAHARA",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-06-27",
        "last_updated": "2021-04-27",
        "certification_date": "2021-04-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MI",
            "license": "4901004760",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1740620376",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jack a Dekkinga MD PC
• Jennifer Jacobusse
• Jacquelyn Kellogg, LLC
• James a. Kessel, DDS, PC
• James M Pouillon DPM PLC
• Jane J Jawahir MD PC
• Hailee Madisen Jarchow, BEHAVIOR TECHNICIAN
• Jason C. Doublestein, D.D.S., P.L.L.C.
• Jemh Group
• Jenna Wierenga, PSYD LLC

• Optometrist in Grandville, MI
• Providers in Grandville, MI by specialty
• Optometrist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 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.