Basic Information
| Provider Information | |||||||||
| NPI: | 1831304476 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | BRETT A HINES OD PSC | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | FAMILY FOCUS EYECARE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 2230 BYPASS RD | ||||||||
| Address2: | |||||||||
| City: | PARIS | ||||||||
| State: | KY | ||||||||
| PostalCode: | 403611282 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8599877077 | ||||||||
| FaxNumber: | 8599877064 | ||||||||
| Practice Location | |||||||||
| Address1: | 2230 BYPASS RD | ||||||||
| Address2: | |||||||||
| City: | PARIS | ||||||||
| State: | KY | ||||||||
| PostalCode: | 403611282 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8599877077 | ||||||||
| FaxNumber: | 8599877064 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/14/2007 | ||||||||
| LastUpdateDate: | 06/23/2008 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | HINES | ||||||||
| AuthorizedOfficialFirstName: | BRETT | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8592341424 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | OD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
No ID Information.