Provider Demographics
NPI:1679994321
Name:CENTRO OFTALMOLOGICO LOPEZ, PSC
Entity type:Organization
Organization Name:CENTRO OFTALMOLOGICO LOPEZ, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAUL
Authorized Official - Middle Name:ERLANDO
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:787-882-0592
Mailing Address - Street 1:PO BOX 250431
Mailing Address - Street 2:
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00604-0431
Mailing Address - Country:US
Mailing Address - Phone:787-882-0592
Mailing Address - Fax:787-882-0562
Practice Address - Street 1:CARR 110 KM 0.3
Practice Address - Street 2:SUITE 2, BO. CEIBA BAJA
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603
Practice Address - Country:US
Practice Address - Phone:787-882-0592
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-26
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14569207W00000X
207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty