Provider Demographics
NPI:1346528569
Name:HOPKINS, BRYAN JOSEPH (OD)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:JOSEPH
Last Name:HOPKINS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:15933 CLAYTON RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63011-2172
Mailing Address - Country:US
Mailing Address - Phone:636-200-4393
Mailing Address - Fax:636-527-0766
Practice Address - Street 1:10 LINCOLN HWY
Practice Address - Street 2:
Practice Address - City:FAIRVIEW HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:62208-2100
Practice Address - Country:US
Practice Address - Phone:618-624-0222
Practice Address - Fax:618-624-4930
Is Sole Proprietor?:No
Enumeration Date:2011-07-22
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046-010491152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MH2428236OtherDEA
IL046-010491OtherIL LICENSE
IL346.003233OtherCONTROLLED SUBSTANCE