Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 0544 | NH |
NPI | 1003811191 |
---|---|
Provider Name | Henry Agustin Lopez |
First Address | Merrimack, NH 03054-4169 |
Second Address | Nashua, NH 03063-3292 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
30010494 | (05) | NH |
T90724 | (02) |