Provider Demographics
NPI:1811038292
Name:DR BRETT A HINES PSC
Entity Type:Organization
Organization Name:DR BRETT A HINES PSC
Other - Org Name:CYNTHIANA VISION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:A
Authorized Official - Last Name:HINES
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:859-234-1424
Mailing Address - Street 1:308 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CYNTHIANA
Mailing Address - State:KY
Mailing Address - Zip Code:41031-1210
Mailing Address - Country:US
Mailing Address - Phone:859-234-1424
Mailing Address - Fax:859-234-5463
Practice Address - Street 1:308 N MAIN ST
Practice Address - Street 2:
Practice Address - City:CYNTHIANA
Practice Address - State:KY
Practice Address - Zip Code:41031-1210
Practice Address - Country:US
Practice Address - Phone:859-234-1424
Practice Address - Fax:859-234-5463
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1320DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1104730001Medicare NSC
KY9355101Medicare PIN