Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 2364TG | TX |
NPI | 1033268842 |
---|---|
Provider Name | Dr. John Hopps Fain JR. |
First Address | Mesquite, TX 75150-4736 |
Second Address | Mesquite, TX 75150-4736 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/01/2007 |
Last Update Date | 15/09/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
019968901 | (05) | TX |
2364TG | STATE LICENSE NUMBER (01) | TX |
T13216 | (02) | TX |