Provider Demographics
NPI:1821057647
Name:MEZU-NDUBUISI, OLACHI JOY (MD OD)
Entity Type:Individual
Prefix:DR
First Name:OLACHI
Middle Name:JOY
Last Name:MEZU-NDUBUISI
Suffix:
Gender:F
Credentials:MD OD
Other - Prefix:DR
Other - First Name:OLACHI
Other - Middle Name:JOY
Other - Last Name:MEZU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD, OD
Mailing Address - Street 1:5767 WILSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:FITCHBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53711-6405
Mailing Address - Country:US
Mailing Address - Phone:410-905-7090
Mailing Address - Fax:
Practice Address - Street 1:5767 WILSHIRE DR
Practice Address - Street 2:
Practice Address - City:FITCHBURG
Practice Address - State:WI
Practice Address - Zip Code:53711-6405
Practice Address - Country:US
Practice Address - Phone:410-905-7090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA1855152W00000X, 152WC0802X, 152WL0500X, 152WP0200X, 152WS0006X, 152WV0400X, 152WX0102X
MDD00647302080N0001X, 208000000X
NY316647363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
No152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WS0006XEye and Vision Services ProvidersOptometristSports Vision
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
No152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant