Provider Demographics
NPI:1568472058
Name:LOPEZ, DAVID RAY (OD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:RAY
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1950 OLD GALLOWS RD STE 520
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3970
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:571-223-6780
Practice Address - Street 1:724 BEECHNUT ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77096-1619
Practice Address - Country:US
Practice Address - Phone:713-666-2277
Practice Address - Fax:713-666-1834
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2331TG152W00000X
TX2331152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0373490Medicaid
TXU58629Medicare UPIN
TX0373490Medicaid