Provider Demographics
NPI:1003875543
Name:HOPPER, RAYMOND A (O D)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:A
Last Name:HOPPER
Suffix:
Gender:M
Credentials:O D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9795 CROSSPOINT BLVD
Mailing Address - Street 2:STE 100
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-3348
Mailing Address - Country:US
Mailing Address - Phone:317-254-6480
Mailing Address - Fax:317-259-8609
Practice Address - Street 1:1419 S REED RD
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46902-1927
Practice Address - Country:US
Practice Address - Phone:765-459-8182
Practice Address - Fax:765-459-5550
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2018-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18001902A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100279530Medicaid
T35213Medicare UPIN
IN410049418Medicare PIN
IN296080KMedicare PIN
IN198670HMedicare PIN
IN100279530Medicaid