Provider Demographics
NPI:1215682257
Name:LOPEZ, ARTHUR R (OPTICAL OWNER)
Entity type:Individual
Prefix:MR
First Name:ARTHUR
Middle Name:R
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:OPTICAL OWNER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12715 ENGELMANN # 102
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78249-4902
Mailing Address - Country:US
Mailing Address - Phone:210-318-7817
Mailing Address - Fax:
Practice Address - Street 1:6515 BANDERA RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78238-1434
Practice Address - Country:US
Practice Address - Phone:210-318-7817
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-17
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX156FC0801X, 156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty
No156FC0801XEye and Vision Services ProvidersTechnician/TechnologistContact Lens Fitter