Provider Demographics
NPI:1316783103
Name:LOPEZ, JACOB D (OD)
Entity type:Individual
Prefix:DR
First Name:JACOB
Middle Name:D
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:22205 ROLLING HILLS LN
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92887-2710
Mailing Address - Country:US
Mailing Address - Phone:714-313-1366
Mailing Address - Fax:
Practice Address - Street 1:10837 LAUREL ST STE 103
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-0632
Practice Address - Country:US
Practice Address - Phone:909-477-8810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-02
Last Update Date:2025-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35795-TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist