Provider Demographics
NPI:1689633471
Name:MEZU EYE CARE
Entity Type:Organization
Organization Name:MEZU EYE CARE
Other - Org Name:AQUA VISION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF MEDICAL OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:KELECHI
Authorized Official - Middle Name:R
Authorized Official - Last Name:MEZU
Authorized Official - Suffix:
Authorized Official - Credentials:OD DRPH
Authorized Official - Phone:410-602-1567
Mailing Address - Street 1:1400 REISTERSTOWN RD
Mailing Address - Street 2:PIKESVILLE SHOPPING CENTER
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-3806
Mailing Address - Country:US
Mailing Address - Phone:410-602-1567
Mailing Address - Fax:
Practice Address - Street 1:1400 REISTERSTOWN RD
Practice Address - Street 2:PIKESVILLE SHOPPING CENTER
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208-3806
Practice Address - Country:US
Practice Address - Phone:410-602-1567
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA1714152W00000X, 152WC0802X, 152WL0500X, 152WP0200X, 152WS0006X, 152WV0400X, 152WX0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Not Answered152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
Not Answered152WL0500XEye and Vision Services ProvidersOptometristLow Vision RehabilitationGroup - Single Specialty
Not Answered152WP0200XEye and Vision Services ProvidersOptometristPediatricsGroup - Single Specialty
Not Answered152WS0006XEye and Vision Services ProvidersOptometristSports VisionGroup - Single Specialty
Not Answered152WV0400XEye and Vision Services ProvidersOptometristVision TherapyGroup - Single Specialty
Not Answered152WX0102XEye and Vision Services ProvidersOptometristOccupational VisionGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD3303001OtherAETNA
MD33606OtherAVEISIS PROVIDER NUMBER
MD210461OtherNATIONAL VISION ADMINISTR
MDF534OtherFEDERAL BLUE CROSS
MD25805OtherSPECTERA
MD4106021567OtherVSP IDENTIFIER NUMBER
MDF534-001OtherBLUE CROSS BLUE CHOICE
MDMD1714OtherEYEMED VISION CARE
MD61279002OtherBLUE CROSS BLUE SHIELD
MD2169OtherBALTIMORE CITY VISION PLA
MD25805OtherSPECTERA
MD61279002OtherBLUE CROSS BLUE SHIELD