Active NPI
Denisse Evelyn Villa Lopez
- Optician
- Tucker, GA
National Provider Identifier
1609654441
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optician
- License
- 002738
- Practice address
- 4375 Lawrenceville Hwy
Tucker, GA 30084-3702 - Phone
- (770) 939-7576
- Fax
- (770) 939-0212
- NPI assigned
- Sep 21, 2023
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optician | 156FX1800X | 002738 | GA | Primary |
Addresses
Primary practice location
4375 Lawrenceville Hwy
Tucker, GA 30084-3702
Mailing address
4375 Lawrenceville Hwy
Tucker, GA 30084-3702
Phone (770) 939-7576
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 002738 | GA | MD | Diagnostic Radiology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1695254400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1695254400000",
"number": "1609654441",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4375 LAWRENCEVILLE HWY",
"city": "TUCKER",
"state": "GA",
"postal_code": "300843702",
"telephone_number": "770-939-7576",
"fax_number": "770-939-0212"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4375 LAWRENCEVILLE HWY",
"city": "TUCKER",
"state": "GA",
"postal_code": "300843702",
"telephone_number": "770-939-7576",
"fax_number": "770-939-0212"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VILLA LOPEZ",
"first_name": "DENISSE",
"middle_name": "EVELYN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2023-09-21",
"last_updated": "2023-09-21",
"certification_date": "2023-09-21",
"status": "A"
},
"taxonomies": [
{
"code": "156FX1800X",
"taxonomy_group": "",
"desc": "Technician/Technologist, Optician",
"state": "GA",
"license": "002738",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tucker, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.