Provider Demographics
NPI:1033268842
Name:FAIN, JOHN HOPPS JR (OD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:HOPPS
Last Name:FAIN
Suffix:JR
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1950 OLD GALLOWS RD STE 520
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3970
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:571-223-6780
Practice Address - Street 1:610 N TOWN EAST BLVD STE 100
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-4705
Practice Address - Country:US
Practice Address - Phone:972-279-2020
Practice Address - Fax:972-279-2637
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2364TG152WC0802X
TX2364152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX019968901Medicaid
TX2364TGOtherSTATE LICENSE NUMBER
TX2364TGOtherSTATE LICENSE NUMBER
TXT13216Medicare UPIN
TX019968901Medicaid