Provider Demographics
NPI:1588389373
Name:ORCHARD EYECARE
Entity type:Organization
Organization Name:ORCHARD EYECARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:GERAL
Authorized Official - Middle Name:
Authorized Official - Last Name:MESADIEU
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:954-594-6831
Mailing Address - Street 1:6191 WEALTHY LN
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-7812
Mailing Address - Country:US
Mailing Address - Phone:954-594-6831
Mailing Address - Fax:
Practice Address - Street 1:1315 N 21ST ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-3090
Practice Address - Country:US
Practice Address - Phone:740-364-9130
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-05
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty