Provider Demographics
NPI:1386893428
Name:HERNANDEZ RIVERA, CARMEN (OPTICIAN)
Entity type:Individual
Prefix:MRS
First Name:CARMEN
Middle Name:
Last Name:HERNANDEZ RIVERA
Suffix:
Gender:F
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:529 E 138TH ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10454-4925
Mailing Address - Country:US
Mailing Address - Phone:718-618-7543
Mailing Address - Fax:718-618-7545
Practice Address - Street 1:529 E 138TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10454-4925
Practice Address - Country:US
Practice Address - Phone:718-618-7543
Practice Address - Fax:718-618-7545
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-12
Last Update Date:2008-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008692156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician