Provider Demographics
NPI:1043501596
Name:HOPPER, BRENDA M (LICENSED OPTICIAN)
Entity Type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:M
Last Name:HOPPER
Suffix:
Gender:F
Credentials:LICENSED OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2305 OLD STATE ROUTE 32
Mailing Address - Street 2:APT F
Mailing Address - City:BATAVIA
Mailing Address - State:OH
Mailing Address - Zip Code:45103-1979
Mailing Address - Country:US
Mailing Address - Phone:513-304-0208
Mailing Address - Fax:
Practice Address - Street 1:1 NEUMANN WAY
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45215-1915
Practice Address - Country:US
Practice Address - Phone:513-243-2946
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-02
Last Update Date:2011-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS-6587156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH27-3752924OtherANTHEM