Provider Demographics
NPI:1689456006
Name:BOPP, TYLER (HIS)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:
Last Name:BOPP
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15060 W GREENFIELD AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-7061
Mailing Address - Country:US
Mailing Address - Phone:262-789-5337
Mailing Address - Fax:
Practice Address - Street 1:15060 W GREENFIELD AVE STE 100
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-7061
Practice Address - Country:US
Practice Address - Phone:262-789-5337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-19
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2025-60237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist