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General NPI Number Information
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NPI Number | 1710408992
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Entity Type | Individual
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Provider Name | DENISE LYNN MEZQUIA O.D.
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Gender | Female
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Dates
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Enumeration Date | 06/28/2017
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Last Update Date | 07/11/2019
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Provider Practice Location Address
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Address Line | 1800 PEMBROOK DR STE 120
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City | ORLANDO
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State | FL
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Zip | 32810
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Country | US
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Telephone | 407-586-7992
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Fax |
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Provider Business Mailing Address
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Address Line | 13400 HIGHLAND WOODS DR
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City | CLERMONT
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State | FL
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Zip | 34711-8536
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Country | US
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Telephone | 786-385-2708
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Fax | 518-599-0966
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | T008563
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPC5483
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License Number State | FL
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