Provider Demographics
NPI:1992846935
Name:LOPEZ, ENRIQUE (OPTICIAN)
Entity Type:Individual
Prefix:MR
First Name:ENRIQUE
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1740 PALM AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33010-2673
Mailing Address - Country:US
Mailing Address - Phone:305-885-0606
Mailing Address - Fax:305-885-4333
Practice Address - Street 1:1740 PALM AVE STE 4
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33010-2673
Practice Address - Country:US
Practice Address - Phone:305-885-0606
Practice Address - Fax:305-885-4333
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDO 4836156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician