Provider Demographics
NPI:1669218988
Name:LOPEZ, MARLON (LDO)
Entity type:Individual
Prefix:
First Name:MARLON
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 IRIS RD
Mailing Address - Street 2:
Mailing Address - City:LEVITTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19057-2724
Mailing Address - Country:US
Mailing Address - Phone:908-397-6468
Mailing Address - Fax:
Practice Address - Street 1:152 ROUTE 31
Practice Address - Street 2:
Practice Address - City:FLEMINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08822-5734
Practice Address - Country:US
Practice Address - Phone:908-788-7587
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-05
Last Update Date:2024-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ31TD00412500156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician