MEDICARE: DR. EVA JOSEFINA LOPEZ-MENDEZ O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	176	PR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	58234 LO	OTHER	PR	HEALTH CARE PLAN TRIPLE-S

General Provider Information

NPI Number	:	1033152749
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EVA JOSEFINA LOPEZ-MENDEZ O.D.

Provider Business Mailing Address
First Line	:	470 CAMINO LOS TAMARINDOS
Second Line	:	SABANERA DEL RIO
City	:	GURABO
State	:	PR
Zip	:	00778
Country	:	US
Telephone Number	:	787-745-4099
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 AVE.RAFAEL CORDERO
Second Line	:	SUITE 111
City	:	CAGUAS
State	:	PR
Zip	:	00725-3757
Country	:	US
Telephone Number	:	787-703-0169
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2006
Last Update Date	:	07/08/2007

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Directions to “ DR. EVA JOSEFINA LOPEZ-MENDEZ O.D.” Practice Location

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