Provider Demographics
NPI:1508965104
Name:MEMOLI, KAREN M (OD)
Entity type:Individual
Prefix:DR
First Name:KAREN
Middle Name:M
Last Name:MEMOLI
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 11407
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35246-8575
Mailing Address - Country:US
Mailing Address - Phone:864-359-1308
Mailing Address - Fax:
Practice Address - Street 1:1331 S SUMTER BLVD
Practice Address - Street 2:
Practice Address - City:NORTH PORT
Practice Address - State:FL
Practice Address - Zip Code:34287-2339
Practice Address - Country:US
Practice Address - Phone:239-466-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2025-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 3367152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL620459700Medicaid
FL77323Medicare UPIN
FL3184 DMedicare ID - Type UnspecifiedINDIVIDUAL