Organization
AQUA VISION CARE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KELECHI MEZU OD, DR.PH (DIRECTOR)
(410) 602-1567
Entity
Organization
Contact information
Practice address
1006 REISTERSTOWN RD, PIKESVILLE, MD 21208-4206
(410) 602-1567
(410) 602-1568
Mailing address
1006 REISTERSTOWN RD, PIKESVILLE, MD 21208-4206
(410) 602-1567
(410) 602-1568
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
TA1714
MD
152WC0802X
Corneal and Contact Management Optometrist
TA1714
MD
152WL0500X
Low Vision Rehabilitation Optometrist
TA1714
MD
152WP0200X
Pediatric Optometrist
TA1714
MD
152WS0006X
Sports Vision Optometrist
TA1714
MD
152WV0400X
Vision Therapy Optometrist
TA1714
MD
152WX0102X
Occupational Vision Optometrist
TA1714
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
210461
NATIONAL VISION ADMINISTR
MD
01
—
2169
BALTIMORE CITY VISION PLA
MD
01
—
3303001
AETNA
MD
01
—
33606
AVEISIS PROVIDER NUMBER
MD
01
—
4106021567
VSP IDENTIFIER NUMBER
MD
05
—
550003600
—
MD
01
—
61279002
BLUE CROSS BLUE SHIELD
MD
01
—
F534
FEDERAL BLUE CROSS
MD
01
—
F534-001
BLUE CROSS BLUE CHOICE
MD
01
—
MD1714
EYEMED VISION CARE
MD
Enumeration date
03/26/2013
Last updated
03/26/2013
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