Provider Demographics
NPI:1932191236
Name:HINZE, ROY W (OD)
Entity type:Individual
Prefix:DR
First Name:ROY
Middle Name:W
Last Name:HINZE
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 1:5 S 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-3106
Mailing Address - Country:US
Mailing Address - Phone:509-248-2020
Mailing Address - Fax:509-248-2010
Practice Address - Street 1:5 S 12TH AVE
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-3106
Practice Address - Country:US
Practice Address - Phone:509-248-2020
Practice Address - Fax:509-248-2010
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-22
Last Update Date:2008-01-07
Deactivation Date:2006-03-27
Deactivation Code:
Reactivation Date:2006-04-03
Provider Licenses
StateLicense IDTaxonomies
WA848152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2238202Medicaid
WAT02067Medicare UPIN
WA0320510001Medicare NSC