Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 152W00000X | Optometrist | 860 | OK |
Y | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 860 | OK |
N | 152WL0500X | Optomitrist - Low Vision Rehabilitation | 860 | OK |
N | 152WP0200X | Pediatric Optomitrist | 860 | OK |
N | 152WX0102X | Occupational Vision | 860 | OK |
NPI | 1255338315 |
---|---|
Provider Name | Dr. Jack E Hopkins |
First Address | Midwest City, OK 73110-7530 |
Second Address | Midwest City, OK 73110-7530 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2005 |
Last Update Date | 28/07/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100765510A | (05) | OK |
410020540 | RAILROAD MEDICARE (01) | OK |
T40508 | (02) | OK |