Provider Demographics
NPI:1477806255
Name:LOPEZ, MATTHEW RYAN (OD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:RYAN
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 1:15600 N FRANK LLOYD WRIGHT BLVD
Mailing Address - Street 2:APT. 1055
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-2201
Mailing Address - Country:US
Mailing Address - Phone:407-970-0974
Mailing Address - Fax:
Practice Address - Street 1:9820 W LOWER BUCKEYE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:TOLLESON
Practice Address - State:AZ
Practice Address - Zip Code:85353-1405
Practice Address - Country:US
Practice Address - Phone:407-970-0974
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-18
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1886152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist