Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | S-6587 | OH |
NPI | 1043501596 |
---|---|
Provider Name | Mrs. Brenda M Hopper |
First Address | Batavia, OH 45103-1979 |
Second Address | Cincinnati, OH 45215-1915 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2011 |
Last Update Date | 02/05/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
27-3752924 | ANTHEM (01) | OH |