Provider Demographics
NPI:1477682664
Name:LOPEZ, ERNESTO RAMON (OPTICIAN)
Entity Type:Individual
Prefix:
First Name:ERNESTO
Middle Name:RAMON
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8738 SW 24TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-2006
Mailing Address - Country:US
Mailing Address - Phone:305-552-7455
Mailing Address - Fax:
Practice Address - Street 1:8738 SW 24TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-2006
Practice Address - Country:US
Practice Address - Phone:305-552-7455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFL2071156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician