Provider Demographics
NPI:1871841064
Name:LOPEZ, RAUL (LDO)
Entity Type:Individual
Prefix:MR
First Name:RAUL
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1550 W 84TH ST STE 15
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33014-3368
Mailing Address - Country:US
Mailing Address - Phone:786-587-7404
Mailing Address - Fax:
Practice Address - Street 1:1550 W 84TH ST STE 15
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33014-3368
Practice Address - Country:US
Practice Address - Phone:786-587-7404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-21
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDO6361156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician