Provider Demographics
NPI:1255338315
Name:HOPKINS, JACK E (OD)
Entity type:Individual
Prefix:DR
First Name:JACK
Middle Name:E
Last Name:HOPKINS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:8121 NATIONAL AVE
Mailing Address - Street 2:STE 409
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73110-7530
Mailing Address - Country:US
Mailing Address - Phone:405-737-8935
Mailing Address - Fax:405-737-8934
Practice Address - Street 1:8121 NATIONAL AVE
Practice Address - Street 2:STE 409
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73110-7530
Practice Address - Country:US
Practice Address - Phone:405-737-8935
Practice Address - Fax:405-737-8934
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-05
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK860152W00000X, 152WC0802X, 152WL0500X, 152WP0200X, 152WX0102X, 332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152W00000XEye and Vision Services ProvidersOptometrist
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
No332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100765510AMedicaid
OK410020540OtherRAILROAD MEDICARE
OK0473950001Medicare NSC
OKT40508Medicare UPIN