Provider Demographics
NPI:1811484173
Name:HOOPER PREVENTATIVE EYECARE CLINIC INC.
Entity type:Organization
Organization Name:HOOPER PREVENTATIVE EYECARE CLINIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:HOOPER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:440-799-4311
Mailing Address - Street 1:19358 DETROIT RD STE A
Mailing Address - Street 2:
Mailing Address - City:ROCKY RIVER
Mailing Address - State:OH
Mailing Address - Zip Code:44116-1802
Mailing Address - Country:US
Mailing Address - Phone:440-799-4311
Mailing Address - Fax:440-398-8040
Practice Address - Street 1:19358 DETROIT RD STE A
Practice Address - Street 2:
Practice Address - City:ROCKY RIVER
Practice Address - State:OH
Practice Address - Zip Code:44116-1802
Practice Address - Country:US
Practice Address - Phone:440-799-4311
Practice Address - Fax:440-398-8040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-21
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6285-T3201152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0293505Medicaid
OH0132643Medicaid