Provider Demographics
NPI:1841337425
Name:HINES, WAYNE GENE (OD)
Entity type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:GENE
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 1:5270 SAINT ALBANS BAY RD
Mailing Address - Street 2:
Mailing Address - City:EXCELSIOR
Mailing Address - State:MN
Mailing Address - Zip Code:55331-8635
Mailing Address - Country:US
Mailing Address - Phone:952-474-2654
Mailing Address - Fax:952-474-2654
Practice Address - Street 1:14120 COMMERCE AVE NE
Practice Address - Street 2:SUITE 100
Practice Address - City:PRIOR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55372-1500
Practice Address - Country:US
Practice Address - Phone:952-447-2020
Practice Address - Fax:952-447-2322
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN0001425152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN2223987OtherUINTED HEALTHCARE
MNHP15419OtherHEALTHPARTNERS
MN2223987OtherMEDICA
MN2223987OtherSELECT CARE
MN0314340001OtherADMINISTAR
MN1014529OtherPREFERRED ONE
MN2123989OtherMEDICA DISPENSING
MN87852HIOtherBCBSMN
MNT65622Medicare UPIN
MN2123989OtherMEDICA DISPENSING