Provider Demographics
NPI:1194859363
Name:MEZU, KELECHI R (OD DRPH)
Entity Type:Individual
Prefix:DR
First Name:KELECHI
Middle Name:R
Last Name:MEZU
Suffix:
Gender:F
Credentials:OD DRPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1006 REISTERSTOWN RD
Mailing Address - Street 2:
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-4206
Mailing Address - Country:US
Mailing Address - Phone:410-602-1567
Mailing Address - Fax:410-602-1568
Practice Address - Street 1:1006 REISTERSTOWN RD
Practice Address - Street 2:
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208-4206
Practice Address - Country:US
Practice Address - Phone:410-602-1567
Practice Address - Fax:410-602-1568
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2019-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA1714152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist