Provider Demographics
NPI:1164164794
Name:HOPPE, TARA ELIZABETH-MARIE (OD)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:ELIZABETH-MARIE
Last Name:HOPPE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2510 W 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54904-8125
Mailing Address - Country:US
Mailing Address - Phone:920-235-3195
Mailing Address - Fax:
Practice Address - Street 1:2510 W 9TH AVE
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54904-8125
Practice Address - Country:US
Practice Address - Phone:920-426-2020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-13
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3739-35152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist