MEDICARE: ADRIEL LOPEZ 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	3360TG	TX
2	152W00000X	Optometrist	1238	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1902837891
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADRIEL LOPEZ O.D.

Provider Business Mailing Address
First Line	:	4436 PACK SADDLE PASS
Second Line	:	SUITE B
City	:	AUSTIN
State	:	TX
Zip	:	78745-1624
Country	:	US
Telephone Number	:	512-444-7200
Fax Number	:	512-444-7489

Provider Business Practice Location Address
First Line	:	4436 PACK SADDLE PASS
Second Line	:	SUITE B
City	:	AUSTIN
State	:	TX
Zip	:	78745-1624
Country	:	US
Telephone Number	:	512-444-7200
Fax Number	:	512-444-7489

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

Provider Enumeration Date	:	07/06/2006
Last Update Date	:	11/26/2014

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