Provider Demographics
NPI:1841069655
Name:KONOU, ROMAIN ENYONAM (OPTICIAN)
Entity type:Individual
Prefix:
First Name:ROMAIN
Middle Name:ENYONAM
Last Name:KONOU
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2696 TRITT SPRINGS TRCE NE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-5263
Mailing Address - Country:US
Mailing Address - Phone:862-452-6084
Mailing Address - Fax:770-410-8840
Practice Address - Street 1:2696 TRITT SPRINGS TRCE NE
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-5263
Practice Address - Country:US
Practice Address - Phone:862-452-6084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-21
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALDO002986156FC0800X, 156FC0801X, 156FX1800X
GAABO-NCLE234728156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty
No156FC0800XEye and Vision Services ProvidersTechnician/TechnologistContact Lens
No156FC0801XEye and Vision Services ProvidersTechnician/TechnologistContact Lens Fitter