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General NPI Number Information
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NPI Number | 1760587455
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Entity Type | Organization
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Legal Business Name | EDWARD M. LOPEZ
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Dates
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Enumeration Date | 09/14/2006
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Last Update Date | 12/22/2008
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Provider Practice Location Address
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Address Line | 116 E PINE ST
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City | CLEARFIELD
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State | PA
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Zip | 16830-2541
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Country | US
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Telephone | 814-765-6579
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Fax | 814-765-6570
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Provider Business Mailing Address
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Address Line | 116 E PINE ST
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City | CLEARFIELD
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State | PA
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Zip | 16830-2541
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Country | US
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Telephone | 814-765-6579
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Fax | 814-765-6570
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Authorized Official
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Title or Position | SOLE PROPRIETOR
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Name | EDWARD MATTHEW LOPEZ
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Credential | O.D.
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Telephone | 814-765-6579
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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 | OEG000025
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License Number State | PA
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