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General NPI Number Information
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NPI Number | 1043065782
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Entity Type | Individual
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Provider Name | CRISTIAN LOPEZ
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Gender | Male
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Dates
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Enumeration Date | 04/17/2024
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Last Update Date | 10/28/2024
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Provider Practice Location Address
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Address Line | 2555 COURT DR STE 150
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City | GASTONIA
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State | NC
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Zip | 28054-2187
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Country | US
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Telephone | 704-864-7789
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Fax |
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Provider Business Mailing Address
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Address Line | 65 SKY EXCHANGE DR APT 301
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City | ASHEVILLE
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State | NC
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Zip | 28803-0356
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Country | US
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Telephone | 828-564-3536
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 2821
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License Number State | NC
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