Provider Demographics
NPI:1386736726
Name:MESARCH, LAWRENCE JONATHAN (OD)
Entity type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:JONATHAN
Last Name:MESARCH
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 S WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:OH
Mailing Address - Zip Code:43138-1317
Mailing Address - Country:US
Mailing Address - Phone:740-385-4006
Mailing Address - Fax:740-385-4043
Practice Address - Street 1:57 S WALNUT ST
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:OH
Practice Address - Zip Code:43138-1317
Practice Address - Country:US
Practice Address - Phone:740-385-4006
Practice Address - Fax:740-385-4043
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5564152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2622497Medicaid
OHVO7158Medicare UPIN
OHME4172281Medicare ID - Type Unspecified