Organization
MARK T LOPEZ OD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK LOPEZ (DOCTOR)
(860) 464-6060
Entity
Organization
Contact information
Practice address
1026 LONG COVE RD, GALES FERRY, CT 06335-1812
(860) 464-6060
(860) 464-7013
Mailing address
1026 LONG COVE RD, P.O. BOX 336, GALES FERRY, CT 06335-1812
(860) 464-6060
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
CT856
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004021507
—
CT
Enumeration date
03/26/2008
Last updated
02/04/2011
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