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General NPI Number Information
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NPI Number | 1265099154
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Entity Type | Individual
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Provider Name | ELENA LOPEZ CHAN
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Gender | Female
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Dates
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Enumeration Date | 05/26/2019
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Last Update Date | 02/21/2024
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Provider Practice Location Address
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Address Line | 18500 VETERANS BLVD UNIT 4
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City | PORT CHARLOTTE
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State | FL
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Zip | 33954-1035
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Country | US
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Telephone | 941-743-7449
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Fax |
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Provider Business Mailing Address
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Address Line | 2623 SW 4TH LN
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City | CAPE CORAL
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State | FL
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Zip | 33991-1118
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Country | US
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Telephone |
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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 | OPC5646
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License Number State | FL
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