Provider Demographics
NPI:1699852061
Name:LOPEZ, KATHERINE L (OD)
Entity type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:L
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 OLD GALLOWS RD STE 520
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3970
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:571-223-6780
Practice Address - Street 1:54 MONUMENT CIR STE 125
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46204-3047
Practice Address - Country:US
Practice Address - Phone:317-631-1200
Practice Address - Fax:317-631-1600
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002137B152W00000X
IN18002137A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
INV25353Medicare UPIN
IN267950BMedicare ID - Type Unspecified