Provider Demographics
NPI:1659304004
Name:FERNANDO LOPEZ MD SC
Entity Type:Organization
Organization Name:FERNANDO LOPEZ MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FERNANDO
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-859-2680
Mailing Address - Street 1:143 SOUTH LINCOLN AVENUE
Mailing Address - Street 2:SUITE J AURORA MEDICAL PARK
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60505-4290
Mailing Address - Country:US
Mailing Address - Phone:630-859-2680
Mailing Address - Fax:
Practice Address - Street 1:143 SOUTH LINCOLN AVENUE
Practice Address - Street 2:SUITE J AURORA MEDICAL PARK
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60505-4290
Practice Address - Country:US
Practice Address - Phone:630-859-2680
Practice Address - Fax:810-454-2423
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-104977207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK28602Medicare PIN