=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285741298
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GARY R HOPEN M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/24/2006
-----------------------------------------------------
Last Update Date | 03/22/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3419 JOHNSON ST.
-----------------------------------------------------
City | HOLLYWOOD
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33021
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-989-2800
-----------------------------------------------------
Fax | 954-989-2873
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | P.O. BOX 39209
-----------------------------------------------------
City | FT. LAUDERDALE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33339
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-851-9966
-----------------------------------------------------
Fax | 954-318-7360
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number | 39576
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number | ME0039576
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------