Healthcare Provider Details

I. General information

NPI: 1467750018
Provider Name (Legal Business Name): MONICA BIDOT LOPEZ O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2011
Last Update Date: 11/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9000 LOCKHART GDN CTR STE 202
ST THOMAS VI
00802-2685
US

IV. Provider business mailing address

9000 LOCKHART GDN CTR STE 202
ST THOMAS VI
00802-2685
US

V. Phone/Fax

Practice location:
  • Phone: 340-774-8500
  • Fax: 340-774-3704
Mailing address:
  • Phone: 340-774-8500
  • Fax: 340-774-3704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number049
License Number StateVI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: