Provider Demographics
NPI:1669706958
Name:HINSON FAMILY VISION
Entity type:Organization
Organization Name:HINSON FAMILY VISION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:M
Authorized Official - Last Name:HINSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:414-543-0627
Mailing Address - Street 1:12032 W PLAINFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53228-1857
Mailing Address - Country:US
Mailing Address - Phone:414-543-0627
Mailing Address - Fax:414-328-8030
Practice Address - Street 1:3049 S OAKES RD
Practice Address - Street 2:
Practice Address - City:STURTEVANT
Practice Address - State:WI
Practice Address - Zip Code:53177-1961
Practice Address - Country:US
Practice Address - Phone:262-598-8627
Practice Address - Fax:262-598-8629
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-21
Last Update Date:2009-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2081152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty