Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 40979 | CA |
NPI | 1033774468 |
---|---|
Provider Name | Felix Lopez |
First Address | Austin, TX 78753-2658 |
Second Address | La Jolla, CA 92037-1949 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2019 |
Last Update Date | 01/05/2019 |