Provider Demographics
NPI:1356777338
Name:LOPEZ, JESSICA EMILIE (OD)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:EMILIE
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 1:11735 SW 147TH AVE
Mailing Address - Street 2:STE 16
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33196-3312
Mailing Address - Country:US
Mailing Address - Phone:786-953-8200
Mailing Address - Fax:786-953-8647
Practice Address - Street 1:11735 SW 147TH AVE
Practice Address - Street 2:STE 16
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33196-3312
Practice Address - Country:US
Practice Address - Phone:786-953-8200
Practice Address - Fax:786-953-8647
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-23
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC4808152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist