Provider Demographics
NPI:1952324048
Name:HEIN, ALAN E (OD)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:E
Last Name:HEIN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2080 WOODWINDS DR STE 110
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-2537
Mailing Address - Country:US
Mailing Address - Phone:651-578-6949
Mailing Address - Fax:
Practice Address - Street 1:2080 WOODWINDS DR STE 110
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-2537
Practice Address - Country:US
Practice Address - Phone:651-578-6949
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ970152W00000X
IL046-008044152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK22434Medicare ID - Type Unspecified
ILU01772Medicare UPIN