Individual
MARK T LOPEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.P.C.
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, GALES FERRY, CT 06335-1812
(860) 464-6060
(860) 464-7013
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
CT856
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004021507
—
CT
01
—
090000856CT01
BC/BS
CT
01
—
0V2229
HEALTHNET
CT
01
—
1487648051
VSP VISION SERVICE PLAN
CT
Enumeration date
09/09/2005
Last updated
02/23/2010
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