1841337425 NPI number — DR. WAYNE GENE HINES O.D.

Table of content: DR. WAYNE GENE HINES O.D. (NPI 1841337425)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841337425 NPI number — DR. WAYNE GENE HINES O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HINES
Provider First Name:
WAYNE
Provider Middle Name:
GENE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1841337425
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5270 SAINT ALBANS BAY RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EXCELSIOR
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55331-8635
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
952-474-2654
Provider Business Mailing Address Fax Number:
952-474-2654

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14120 COMMERCE AVE NE
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
PRIOR LAKE
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55372-1500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
952-447-2020
Provider Business Practice Location Address Fax Number:
952-447-2322
Provider Enumeration Date:
01/31/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  0001425 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2223987 . This is a "UINTED HEALTHCARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: HP15419 . This is a "HEALTHPARTNERS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 2223987 . This is a "MEDICA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 2223987 . This is a "SELECT CARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 0314340001 . This is a "ADMINISTAR" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 1014529 . This is a "PREFERRED ONE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 2123989 . This is a "MEDICA DISPENSING" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 87852HI . This is a "BCBSMN" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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