Provider Demographics
NPI:1164902391
Name:DIANA C HERNANDEZ OD LLC
Entity Type:Organization
Organization Name:DIANA C HERNANDEZ OD LLC
Other - Org Name:TREASURED EYES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER/OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:CATALINA
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:321-339-2211
Mailing Address - Street 1:964 S WICKHAM RD STE 1
Mailing Address - Street 2:
Mailing Address - City:WEST MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32904-1460
Mailing Address - Country:US
Mailing Address - Phone:321-339-2211
Mailing Address - Fax:
Practice Address - Street 1:964 S WICKHAM RD STE 1
Practice Address - Street 2:
Practice Address - City:WEST MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32904-1460
Practice Address - Country:US
Practice Address - Phone:321-339-2211
Practice Address - Fax:321-339-1183
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-16
Last Update Date:2019-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty