Provider Demographics
NPI:1043920499
Name:LOPEZ, ERICKA MICHELLE (OD)
Entity Type:Individual
Prefix:
First Name:ERICKA
Middle Name:MICHELLE
Last Name:LOPEZ
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 1:1809 MOOR DR
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33461-5720
Mailing Address - Country:US
Mailing Address - Phone:561-307-7637
Mailing Address - Fax:
Practice Address - Street 1:4100 N WICKHAM RD STE 120
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-2483
Practice Address - Country:US
Practice Address - Phone:321-701-6072
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-28
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC6181152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist