Provider Demographics
NPI:1164739686
Name:HERNANDEZ, DAVID C
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:C
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:637 PHILADELPHIA ST
Mailing Address - Street 2:SUITE 311
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15701-1869
Mailing Address - Country:US
Mailing Address - Phone:724-349-0900
Mailing Address - Fax:724-349-0922
Practice Address - Street 1:637 PHILADELPHIA ST
Practice Address - Street 2:SUITE 311
Practice Address - City:INDIANA
Practice Address - State:PA
Practice Address - Zip Code:15701-1869
Practice Address - Country:US
Practice Address - Phone:724-349-0900
Practice Address - Fax:724-349-0922
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-03
Last Update Date:2010-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1700XEye and Vision Services ProvidersTechnician/TechnologistOcularist