Individual
BETHANY LOPEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ABO, NCLE, LDO
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
072634
—
156FX1800X
Optician
DIO-407
HI
Other
Enumeration date
05/23/2023
Last updated
05/24/2023
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