Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 18001902A | IN |
NPI | 1003875543 |
---|---|
Provider Name | Dr. Raymond A. Hopper |
First Address | Indianapolis, IN 46256-3348 |
Second Address | Kokomo, IN 46902-1927 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2006 |
Last Update Date | 23/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100279530 | (05) | IN |
T35213 | (02) |