Provider Demographics
NPI:1548990039
Name:LOZANO, ISABELLA (OD)
Entity type:Individual
Prefix:
First Name:ISABELLA
Middle Name:
Last Name:LOZANO
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 1:1125 AUDACE AVE APT 403
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33426-3492
Mailing Address - Country:US
Mailing Address - Phone:954-670-3978
Mailing Address - Fax:
Practice Address - Street 1:1100 N CONGRESS AVE STE 1010
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426-3333
Practice Address - Country:US
Practice Address - Phone:239-800-1717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-16
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC6103152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist