=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043501596
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BRENDA M HOPPER LICENSED OPTICIAN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/02/2011
-----------------------------------------------------
Last Update Date | 05/02/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1 NEUMANN WAY
-----------------------------------------------------
City | CINCINNATI
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45215-1915
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-243-2946
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2305 OLD STATE ROUTE 32 APT F
-----------------------------------------------------
City | BATAVIA
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45103-1979
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-304-0208
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 156FX1800X
-----------------------------------------------------
Taxonomy Name | Optician
-----------------------------------------------------
License Number | S-6587
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------