Provider Demographics
NPI:1588600324
Name:FERNANDEZ, CARMEN A (OD)
Entity type:Individual
Prefix:DR
First Name:CARMEN
Middle Name:A
Last Name:FERNANDEZ
Suffix:
Gender:F
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:B7 CAMINO ALEJANDRINO
Mailing Address - Street 2:VILLA CLEMENTINA
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-4702
Mailing Address - Country:US
Mailing Address - Phone:787-790-1622
Mailing Address - Fax:787-790-1622
Practice Address - Street 1:B7 CAMINO ALEJANDRINO
Practice Address - Street 2:VILLA CLEMENTINA
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969-4702
Practice Address - Country:US
Practice Address - Phone:787-790-1622
Practice Address - Fax:787-790-1622
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR0247152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRA-287Medicare UPIN
PR51942Medicare ID - Type UnspecifiedMEDICARE
PR660436599Medicare UPIN
PR9500011Medicare UPIN
PR51942Medicare UPIN
PR50549Medicare UPIN
PR215142Medicare UPIN
PR2914Medicare UPIN
PR6570076Medicare UPIN