Provider Demographics
NPI:1396731477
Name:LOPYKINSKI, MICHAEL J (OD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:LOPYKINSKI
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11315 NW 43RD PL
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-7220
Mailing Address - Country:US
Mailing Address - Phone:815-685-1334
Mailing Address - Fax:
Practice Address - Street 1:100 S MILITARY TRL
Practice Address - Street 2:SUITE 6
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33442-3015
Practice Address - Country:US
Practice Address - Phone:954-708-2232
Practice Address - Fax:954-708-2232
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-23
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046009644152W00000X
FLOPC 4152152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL046009644Medicaid
ILK08943Medicare ID - Type Unspecified
IL046009644Medicaid