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General NPI Number Information
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NPI Number | 1376715680
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Entity Type | Organization
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Legal Business Name | MARK T LOPEZ OD PC
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Dates
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Enumeration Date | 03/26/2008
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Last Update Date | 02/04/2011
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Provider Practice Location Address
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Address Line | 1026 LONG COVE RD
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City | GALES FERRY
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State | CT
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Zip | 06335-1812
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Country | US
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Telephone | 860-464-6060
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Fax | 860-464-7013
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Provider Business Mailing Address
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Address Line | 1026 LONG COVE RD P.O. BOX 336
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City | GALES FERRY
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State | CT
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Zip | 06335-1812
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Country | US
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Telephone | 860-464-6060
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Fax |
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. MARK LOPEZ
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Credential |
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Telephone | 860-464-6060
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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 | CT856
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License Number State | CT
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