Provider Demographics
NPI:1801202395
Name:LOPEZ, SARAH (OD)
Entity Type:Individual
Prefix:DR
First Name:SARAH
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 KIRKHAM ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94122-3814
Mailing Address - Country:US
Mailing Address - Phone:415-476-1442
Mailing Address - Fax:415-502-2521
Practice Address - Street 1:95 KIRKHAM ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94122-3814
Practice Address - Country:US
Practice Address - Phone:415-476-1442
Practice Address - Fax:415-502-2521
Is Sole Proprietor?:No
Enumeration Date:2014-07-07
Last Update Date:2016-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008212152W00000X
NYTUV008212390200000X
CA15327152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program