Provider Demographics
NPI:1033152749
Name:LOPEZ-MENDEZ, EVA JOSEFINA (OD)
Entity Type:Individual
Prefix:DR
First Name:EVA
Middle Name:JOSEFINA
Last Name:LOPEZ-MENDEZ
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 1:470 CAMINO LOS TAMARINDOS
Mailing Address - Street 2:SABANERA DEL RIO
Mailing Address - City:GURABO
Mailing Address - State:PR
Mailing Address - Zip Code:00778
Mailing Address - Country:US
Mailing Address - Phone:787-745-4099
Mailing Address - Fax:
Practice Address - Street 1:200 AVE.RAFAEL CORDERO
Practice Address - Street 2:SUITE 111
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-3757
Practice Address - Country:US
Practice Address - Phone:787-703-0169
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR176152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR58234 LOOtherHEALTH CARE PLAN TRIPLE-S