MEDICARE: DR. RYAN DAVID LOPEZ OD

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	34509	CA

General Provider Information

NPI Number	:	1700400777
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RYAN DAVID LOPEZ OD

Provider Business Mailing Address
First Line	:	11725 SAMOLINE AVE
Second Line	:
City	:	DOWNEY
State	:	CA
Zip	:	90241-4715
Country	:	US
Telephone Number	:	562-659-3228
Fax Number	:

Provider Business Practice Location Address
First Line	:	16816 CLARK AVE
Second Line	:
City	:	BELLFLOWER
State	:	CA
Zip	:	90706-5702
Country	:	US
Telephone Number	:	562-925-6591
Fax Number	:

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

Provider Enumeration Date	:	06/04/2020
Last Update Date	:	06/04/2020

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