Provider Demographics
NPI:1235737446
Name:LOPEZ, GABRIEL ENRIQUE (OD)
Entity Type:Individual
Prefix:DR
First Name:GABRIEL
Middle Name:ENRIQUE
Last Name:LOPEZ
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 1:13231 SW 22ND ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-1134
Mailing Address - Country:US
Mailing Address - Phone:305-469-0341
Mailing Address - Fax:
Practice Address - Street 1:20505 S DIXIE HWY STE 559
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33189-1215
Practice Address - Country:US
Practice Address - Phone:786-231-0833
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-12
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC005871152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist