Provider Demographics
NPI:1033358718
Name:HERNANDEZ, MAX (OPTHALMIC DISPENSER)
Entity Type:Individual
Prefix:MR
First Name:MAX
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:OPTHALMIC DISPENSER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:84-02 ROOSEVELT AVE.
Mailing Address - Street 2:STE #8
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372
Mailing Address - Country:US
Mailing Address - Phone:718-205-6563
Mailing Address - Fax:
Practice Address - Street 1:84-02 ROOSEVELT AVE
Practice Address - Street 2:STE #8
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372
Practice Address - Country:US
Practice Address - Phone:718-205-6563
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-19
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008307156FX1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1100XEye and Vision Services ProvidersTechnician/TechnologistOphthalmic