Wayne Gene Hines, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

0001425 Issued in MN

Practice address

14120 Commerce Ave NE
Suite 100
Prior Lake, MN 55372-1500

Phone

(952) 447-2020

Fax

(952) 447-2322

NPI assigned

Jan 31, 2007

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 8

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Crossroads Optometric Clinic, Inc.

  • Optometrist
  • Prior Lake, MN
  • NPI 1164448627
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170201600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1841337425",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5270 SAINT ALBANS BAY RD",
            "city": "EXCELSIOR",
            "state": "MN",
            "postal_code": "553318635",
            "telephone_number": "952-474-2654",
            "fax_number": "952-474-2654"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14120 COMMERCE AVE NE",
            "address_2": "SUITE 100",
            "city": "PRIOR LAKE",
            "state": "MN",
            "postal_code": "553721500",
            "telephone_number": "952-447-2020",
            "fax_number": "952-447-2322"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HINES",
        "first_name": "WAYNE",
        "middle_name": "GENE",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-31",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MN",
            "license": "0001425",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UINTED HEALTHCARE",
            "identifier": "2223987",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHPARTNERS",
            "identifier": "HP15419",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA",
            "identifier": "2223987",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SELECT CARE",
            "identifier": "2223987",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ADMINISTAR",
            "identifier": "0314340001",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED ONE",
            "identifier": "1014529",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA DISPENSING",
            "identifier": "2123989",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSMN",
            "identifier": "87852HI",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Anthony Carl Heaverlo, D.C.
• Sheila Hennen, CNP
• Lauren Torkilsen Hennessy, PA-C
• Hermsen Health and Wellness, PLLC
• Samantha Marie Davidson Hermsen, D.C.
• Sadiq Mahamed Hirsi
• Morgan Claire Hittner-Ashwell, LICSW
• Bridget Nicole Holbrook, PA-C
• Todd H Holm, M.D.
• Katherine Ann Huntington, PA

• Optometrist in Prior Lake, MN
• Providers in Prior Lake, MN by specialty
• Optometrist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.