Provider Demographics
NPI:1184707408
Name:LOPEZ-JIMENEZ, MADELEINE M (OD)
Entity type:Individual
Prefix:DR
First Name:MADELEINE
Middle Name:M
Last Name:LOPEZ-JIMENEZ
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:CALLE SALAMANCA 10-7
Mailing Address - Street 2:TORRIMAR
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00966
Mailing Address - Country:US
Mailing Address - Phone:787-403-4877
Mailing Address - Fax:787-787-2500
Practice Address - Street 1:B9 CALLE SANTA CRUZ
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-6902
Practice Address - Country:US
Practice Address - Phone:787-787-2500
Practice Address - Fax:787-946-5888
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR517152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR195994Medicare UPIN