Provider Demographics
NPI:1962593749
Name:HERNANDEZ, DANIEL (OD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:
Last Name:HERNANDEZ
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 1:4181 N PINE ISLAND RD
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33351-6040
Mailing Address - Country:US
Mailing Address - Phone:954-909-4444
Mailing Address - Fax:954-909-4455
Practice Address - Street 1:4181 N PINE ISLAND RD
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33351-6040
Practice Address - Country:US
Practice Address - Phone:954-909-4444
Practice Address - Fax:954-909-4455
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2016-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2769152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL620048600Medicaid
FL620048600Medicaid
FLHZ341AMedicare PIN