1689633471 NPI number — MEZU EYE CARE

Table of content: (NPI 1689633471)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689633471 NPI number — MEZU EYE CARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEZU EYE CARE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1689633471
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1400 REISTERSTOWN RD
Provider Second Line Business Mailing Address:
PIKESVILLE SHOPPING CENTER
Provider Business Mailing Address City Name:
PIKESVILLE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21208-3806
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-602-1567
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1400 REISTERSTOWN RD
Provider Second Line Business Practice Location Address:
PIKESVILLE SHOPPING CENTER
Provider Business Practice Location Address City Name:
PIKESVILLE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21208-3806
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-602-1567
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MEZU
Authorized Official First Name:
KELECHI
Authorized Official Middle Name:
R
Authorized Official Title or Position:
CHIEF MEDICAL OFFICER
Authorized Official Telephone Number:
410-602-1567

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  TA1714 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 152WC0802X , with the licence number: TA1714 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 152WL0500X , with the licence number: TA1714 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 152WP0200X , with the licence number: TA1714 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 152WS0006X , with the licence number: TA1714 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 152WV0400X , with the licence number: TA1714 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 152WX0102X , with the licence number: TA1714 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3303001 . This is a "AETNA" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 33606 . This is a "AVEISIS PROVIDER NUMBER" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 210461 . This is a "NATIONAL VISION ADMINISTR" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: F534 . This is a "FEDERAL BLUE CROSS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 25805 . This is a "SPECTERA" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 4106021567 . This is a "VSP IDENTIFIER NUMBER" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: F534-001 . This is a "BLUE CROSS BLUE CHOICE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: MD1714 . This is a "EYEMED VISION CARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 61279002 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 2169 . This is a "BALTIMORE CITY VISION PLA" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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