Provider Demographics
NPI:1003564634
Name:FRANCO LOPEZ, LORAINE J (1439 OPTICO)
Entity Type:Individual
Prefix:MRS
First Name:LORAINE
Middle Name:J
Last Name:FRANCO LOPEZ
Suffix:
Gender:F
Credentials:1439 OPTICO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 2 BOX 4971
Mailing Address - Street 2:
Mailing Address - City:VILLALBA
Mailing Address - State:PR
Mailing Address - Zip Code:00766-9887
Mailing Address - Country:US
Mailing Address - Phone:939-273-1283
Mailing Address - Fax:
Practice Address - Street 1:URB SANTA MARTA CALLE PRINCIPAL CASA 27
Practice Address - Street 2:
Practice Address - City:JUANA DIAZ
Practice Address - State:PR
Practice Address - Zip Code:00795
Practice Address - Country:US
Practice Address - Phone:787-610-4181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-14
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1439332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1439Medicaid