Provider Demographics
NPI:1245377910
Name:ESPEJO, LOUIS A (OD)
Entity type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:A
Last Name:ESPEJO
Suffix:
Gender:M
Credentials:OD
Other - Prefix:DR
Other - First Name:LOUIS
Other - Middle Name:A
Other - Last Name:ESPEJO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:1060 ROCKVILLE PIKE
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-1404
Mailing Address - Country:US
Mailing Address - Phone:301-294-0883
Mailing Address - Fax:
Practice Address - Street 1:1060 ROCKVILLE PIKE
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-1404
Practice Address - Country:US
Practice Address - Phone:301-294-0884
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA1189152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist