Provider Demographics
NPI:1336221647
Name:KINES, THOMAS M (OD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:M
Last Name:KINES
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 1:493 W 3RD STREET
Mailing Address - Street 2:
Mailing Address - City:SYLACAUGA
Mailing Address - State:AL
Mailing Address - Zip Code:35150
Mailing Address - Country:US
Mailing Address - Phone:256-245-7696
Mailing Address - Fax:256-245-6693
Practice Address - Street 1:493 W 3RD STREET
Practice Address - Street 2:
Practice Address - City:SYLACAUGA
Practice Address - State:AL
Practice Address - Zip Code:35150
Practice Address - Country:US
Practice Address - Phone:256-245-7696
Practice Address - Fax:256-245-6693
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS342TA049152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3079375OtherBLUE CROSS
AL000059384Medicaid
AL51059384OtherBLUE CROSS
AL0129390001Medicare NSC
AL51059384OtherBLUE CROSS
AL000059384Medicaid
AL000059384Medicare PIN