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General NPI Number Information
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NPI Number | 1093057226
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Entity Type | Organization
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Legal Business Name | AQUA VISION CARE, LLC
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Dates
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Enumeration Date | 03/26/2013
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Last Update Date | 03/26/2013
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Provider Practice Location Address
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Address Line | 1006 REISTERSTOWN RD
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City | PIKESVILLE
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State | MD
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Zip | 21208-4206
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Country | US
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Telephone | 410-602-1567
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Fax | 410-602-1568
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Provider Business Mailing Address
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Address Line | 1006 REISTERSTOWN RD
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City | PIKESVILLE
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State | MD
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Zip | 21208-4206
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Country | US
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Telephone | 410-602-1567
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Fax | 410-602-1568
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. KELECHI MEZU
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Credential | OD, DR.PH
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Telephone | 410-602-1567
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152WC0802X
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Taxonomy Name | Corneal and Contact Management Optometrist
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License Number | TA1714
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 152WL0500X
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Taxonomy Name | Low Vision Rehabilitation Optometrist
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License Number | TA1714
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License Number State | MD
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Taxonomy #3
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Taxonomy Code | 152WP0200X
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Taxonomy Name | Pediatric Optometrist
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License Number | TA1714
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License Number State | MD
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Taxonomy #4
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Taxonomy Code | 152WS0006X
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Taxonomy Name | Sports Vision Optometrist
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License Number | TA1714
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License Number State | MD
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Taxonomy #5
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Taxonomy Code | 152WV0400X
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Taxonomy Name | Vision Therapy Optometrist
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License Number | TA1714
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License Number State | MD
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Taxonomy #6
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Taxonomy Code | 152WX0102X
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Taxonomy Name | Occupational Vision Optometrist
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License Number | TA1714
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License Number State | MD
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Taxonomy #7
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | TA1714
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License Number State | MD
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