Provider Demographics
NPI:1962595116
Name:FERNANDEZ, CARON K (OD)
Entity type:Individual
Prefix:DR
First Name:CARON
Middle Name:K
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 1:1248 KINOOLE ST STE 1031248
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-4171
Mailing Address - Country:US
Mailing Address - Phone:808-464-4468
Mailing Address - Fax:
Practice Address - Street 1:1248 KINOOLE ST STE 103
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-4171
Practice Address - Country:US
Practice Address - Phone:808-464-4468
Practice Address - Fax:808-969-1924
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2021-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIOD-519152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIA0218824OtherHMSA
HIH100901Medicare PIN
HI100901Medicare ID - Type Unspecified
HIA0218824OtherHMSA