Provider Demographics
NPI:1649949462
Name:LOPEZ, LUIS ALBERTO (LCDO)
Entity type:Individual
Prefix:MR
First Name:LUIS
Middle Name:ALBERTO
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:LCDO
Other - Prefix:MR
Other - First Name:LUIS
Other - Middle Name:ALBERTO
Other - Last Name:LOPEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCDO
Mailing Address - Street 1:1575 AVE JESUS T PINERO
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00920-5403
Mailing Address - Country:US
Mailing Address - Phone:787-519-5134
Mailing Address - Fax:
Practice Address - Street 1:1575 AVE JESUS T PINERO
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00920-5403
Practice Address - Country:US
Practice Address - Phone:787-519-5134
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-07
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1411156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician