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General NPI Number Information
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NPI Number | 1558247916
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Entity Type | Organization
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Legal Business Name | OPTICA LOPEZ 82ND ST QUEENS INC
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Dates
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Enumeration Date | 08/12/2025
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Last Update Date | 10/21/2025
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Provider Practice Location Address
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Address Line | 8201 ROOSEVELT AVE
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City | JACKSON HEIGHTS
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State | NY
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Zip | 11372-7034
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Country | US
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Telephone | 718-478-3539
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Fax | 718-626-5405
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Provider Business Mailing Address
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Address Line | 8201 ROOSEVELT AVE
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City | JACKSON HEIGHTS
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State | NY
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Zip | 11372-7034
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Country | US
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Telephone | 718-478-3539
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Fax | 718-626-5405
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Authorized Official
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Title or Position | OWNER
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Name | WALTER NESSES
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Credential |
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Telephone | 718-478-3539
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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 |
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License Number State |
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