Robert Keith Caudelle, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

1043 Issued in GA

Practice address

320 N Jeff Davis Drive
Suite a
Fayetteville, GA 30214

Phone

(770) 461-2633

Fax

(770) 461-5792

NPI assigned

Jul 24, 2006

Last updated

Dec 29, 2011By the provider in NPPES

Sex

Male

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 2

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

University of Alabama School of Medicine, 1984

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Depoe Eye Center PCGroup PAC ID 8224927702, 14 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Depoe Eye Center PC

  • Optometrist
  • Stockbridge, GA
  • NPI 1073730263
  Medicare reassignment Care Compare group NPD
• Fayette Eye Center PC

  • Optometrist
  • Fayetteville, GA
  • NPI 1881871226
  Authorized official Same address or phone

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

{
    "created_epoch": "1153699200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1325116800000",
    "number": "1750303434",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "320 N JEFF DAVIS DRIVE",
            "address_2": "SUITE A",
            "city": "FAYETTEVILLE",
            "state": "GA",
            "postal_code": "30214",
            "telephone_number": "770-461-2633",
            "fax_number": "770-461-5792"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "320 N JEFF DAVIS DRIVE",
            "address_2": "SUITE A",
            "city": "FAYETTEVILLE",
            "state": "GA",
            "postal_code": "30214",
            "telephone_number": "770-461-2633",
            "fax_number": "770-461-5792"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CAUDELLE",
        "first_name": "ROBERT",
        "middle_name": "KEITH",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-24",
        "last_updated": "2011-12-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "GA",
            "license": "1043",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "410004213",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DMERC",
            "identifier": "0866550001",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Marlo Lee Carter, MD
• Jasmine Cason, PT
• Cat's Pajamas, LTD
• Cato Care LLC (BrightStar Care of Fayetteville)
• Caudelle & Wilson Eye Care LLC
• Allison Sens Cavano, CCC-SLP
• CB & Nikky Inc (Apex Pharmacy)
• Celora Signature Care LLC
• Danko Cerenko, PHD, M.D.
• Dorothy Cerezola, LCSW

• Optometrist in Fayetteville, GA
• Providers in Fayetteville, GA by specialty
• Optometrist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 2011; 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.