Provider Demographics
NPI:1083622211
Name:HOPP, RICHARD HANSEN (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:HANSEN
Last Name:HOPP
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3999 ENGLEWOOD AVE # 101
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-6341
Mailing Address - Country:US
Mailing Address - Phone:509-452-2020
Mailing Address - Fax:509-452-8398
Practice Address - Street 1:3999 ENGLEWOOD AVE # 101
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-6341
Practice Address - Country:US
Practice Address - Phone:509-452-2020
Practice Address - Fax:509-452-8398
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2016-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00027176207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1056233Medicaid
WAE72335Medicare UPIN
WAGAB38966Medicare PIN
WA1080050001Medicare NSC
WAG8856553Medicare PIN