Provider Demographics
NPI:1053926089
Name:COLON LOPEZ, ESTEFANY (OD)
Entity type:Individual
Prefix:DR
First Name:ESTEFANY
Middle Name:
Last Name:COLON 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 1:4313 CORUNNA RD
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-4152
Mailing Address - Country:US
Mailing Address - Phone:810-733-5544
Mailing Address - Fax:810-733-3197
Practice Address - Street 1:4313 CORUNNA RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-4152
Practice Address - Country:US
Practice Address - Phone:810-733-5544
Practice Address - Fax:810-733-3197
Is Sole Proprietor?:No
Enumeration Date:2020-09-15
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901005495152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist