MEDICARE: DR. JACK E HOPKINS O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	860	OK
2	152WC0802X	Corneal and Contact Management Optometrist	860	OK
3	152WL0500X	Low Vision Rehabilitation Optometrist	860	OK
4	152WP0200X	Pediatric Optometrist	860	OK
5	152WX0102X	Occupational Vision Optometrist	860	OK
6	332H00000X	Eyewear Supplier	860	OK

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	410020540	OTHER	OK	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255338315
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JACK E HOPKINS O.D.

Provider Business Mailing Address
First Line	:	8121 NATIONAL AVE
Second Line	:	STE 409
City	:	MIDWEST CITY
State	:	OK
Zip	:	73110-7530
Country	:	US
Telephone Number	:	405-737-8935
Fax Number	:	405-737-8934

Provider Business Practice Location Address
First Line	:	8121 NATIONAL AVE
Second Line	:	STE 409
City	:	MIDWEST CITY
State	:	OK
Zip	:	73110-7530
Country	:	US
Telephone Number	:	405-737-8935
Fax Number	:	405-737-8934

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/05/2005
Last Update Date	:	07/28/2008

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Directions to “ DR. JACK E HOPKINS O.D.” Practice Location

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