Provider Demographics
NPI:1952626988
Name:HINES, THOMAS E (OD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:E
Last Name:HINES
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 1:4716 147TH ST
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:IL
Mailing Address - Zip Code:60445-2527
Mailing Address - Country:US
Mailing Address - Phone:708-597-6550
Mailing Address - Fax:708-597-5975
Practice Address - Street 1:4716 147TH ST
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:IL
Practice Address - Zip Code:60445-2527
Practice Address - Country:US
Practice Address - Phone:708-597-6550
Practice Address - Fax:708-597-5975
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-01
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046-007825152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL3373001Medicare PIN