Healthcare Provider Details

I. General information

NPI: 1902782816
Provider Name (Legal Business Name): RDL OPTOMETRIC SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2025
Last Update Date: 08/14/2025
Certification Date: 08/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13011 NEWPORT AVE STE 101
TUSTIN CA
92780-3516
US

IV. Provider business mailing address

13011 NEWPORT AVE STE 101
TUSTIN CA
92780-3516
US

V. Phone/Fax

Practice location:
  • Phone: 714-544-5282
  • Fax: 714-554-5047
Mailing address:
  • Phone: 714-544-5282
  • Fax: 714-554-5047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. RYAN LOPEZ
Title or Position: OWNER
Credential: OD
Phone: 562-659-3228