Healthcare Provider Details

I. General information

NPI: 1922192731
Provider Name (Legal Business Name): PERRY LOPEZ O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4040 E 82ND ST C-7
INDIANAPOLIS IN
46250-4360
US

IV. Provider business mailing address

4040 E 82ND ST C-7
INDIANAPOLIS IN
46250-4360
US

V. Phone/Fax

Practice location:
  • Phone: 317-595-8855
  • Fax: 317-595-8866
Mailing address:
  • Phone: 317-595-8855
  • Fax: 317-595-8866

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number18002200B
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number18002200B
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: