Provider Demographics
NPI:1710408992
Name:MEZQUIA, DENISE LYNN (OD)
Entity type:Individual
Prefix:DR
First Name:DENISE
Middle Name:LYNN
Last Name:MEZQUIA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13400 HIGHLAND WOODS DR
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-8536
Mailing Address - Country:US
Mailing Address - Phone:786-385-2708
Mailing Address - Fax:518-599-0966
Practice Address - Street 1:1800 PEMBROOK DR STE 120
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32810
Practice Address - Country:US
Practice Address - Phone:407-586-7992
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-28
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYT008563152W00000X
FLOPC5483152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty