Provider Demographics
NPI:1902114036
Name:MESADIEU, GERAL (OD)
Entity Type:Individual
Prefix:DR
First Name:GERAL
Middle Name:
Last Name:MESADIEU
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 1:6191 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:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-23
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6351152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist