=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316521271
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SUSAN HOPPER OD PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/07/2021
-----------------------------------------------------
Last Update Date | 05/07/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 897 NE 8TH ST
-----------------------------------------------------
City | HOMESTEAD
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33030-5021
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-245-7419
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10835 SW 52ND DR
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33165-6966
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-298-0930
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | SUSAN HOPPER
-----------------------------------------------------
Credential | OD
-----------------------------------------------------
Telephone | 305-298-0930
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------