Basic Information
Provider Information | |||||||||
NPI: | 1104834241 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | HOPKINS | ||||||||
FirstName: | KRISTINE | ||||||||
MiddleName: | T. | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | O.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | BECKER | ||||||||
OtherFirstName: | KRISTINE | ||||||||
OtherMiddleName: | T. | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | O.D. | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 1716 UNIVERSITY BLVD | ||||||||
Address2: | HBP G080A | ||||||||
City: | BIRMINGHAM | ||||||||
State: | AL | ||||||||
PostalCode: | 352940010 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2059752020 | ||||||||
FaxNumber: | 2059346755 | ||||||||
Practice Location | |||||||||
Address1: | 1716 UNIVERSITY BLVD | ||||||||
Address2: | HBP G080A | ||||||||
City: | BIRMINGHAM | ||||||||
State: | AL | ||||||||
PostalCode: | 352940010 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2059752020 | ||||||||
FaxNumber: | 2059346755 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/04/2006 | ||||||||
LastUpdateDate: | 02/10/2015 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | S-B03-TA-433 | AL | Y |   | Eye and Vision Services Providers | Optometrist |   |
ID Information
ID | Type | State | Issuer | Description | U77718 | 01 |   | VIVA HEALTH | OTHER | 000051698 | 05 | AL |   | MEDICAID | 410042858 | 01 | AL | RR MEDICARE | OTHER | 1716A 636005396 | 01 |   | VISION SERVICES PLAN | OTHER | 00804258 | 05 | MS |   | MEDICAID | 051051698 | 01 | AL | BLUE CROSS BLUE SHIELD | OTHER | 1586005 | 05 | LA |   | MEDICAID | 51542386 | 01 | AL | BCBS OF ALABAMA | OTHER |