Provider Demographics
NPI:1174989644
Name:DRA. MARIA A. HERNANDEZ IGLESIAS
Entity type:Organization
Organization Name:DRA. MARIA A. HERNANDEZ IGLESIAS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CERTIFY OPTOMETRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:HERNANDEZ IGLESIAS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:787-565-3329
Mailing Address - Street 1:AB12 CALLE NEBRASKA
Mailing Address - Street 2:CAGUAS NORTE
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725-2265
Mailing Address - Country:US
Mailing Address - Phone:787-258-8686
Mailing Address - Fax:787-258-8687
Practice Address - Street 1:310B CALLE CLEMSON
Practice Address - Street 2:UNIVERSITY GARDENS
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00927-4022
Practice Address - Country:US
Practice Address - Phone:787-565-3329
Practice Address - Fax:787-258-8687
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-13
Last Update Date:2016-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR307152W00000X, 152WC0802X, 152WL0500X, 152WP0200X, 156F00000X, 156FC0800X, 156FC0801X, 156FX1100X, 156FX1101X, 156FX1201X, 156FX1202X, 156FX1700X, 156FX1900X, 156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision RehabilitationGroup - Single Specialty
No152WP0200XEye and Vision Services ProvidersOptometristPediatricsGroup - Single Specialty
No156F00000XEye and Vision Services ProvidersTechnician/TechnologistGroup - Single Specialty
No156FC0800XEye and Vision Services ProvidersTechnician/TechnologistContact LensGroup - Single Specialty
No156FC0801XEye and Vision Services ProvidersTechnician/TechnologistContact Lens FitterGroup - Single Specialty
No156FX1100XEye and Vision Services ProvidersTechnician/TechnologistOphthalmicGroup - Single Specialty
No156FX1101XEye and Vision Services ProvidersTechnician/TechnologistOphthalmic AssistantGroup - Single Specialty
No156FX1201XEye and Vision Services ProvidersTechnician/TechnologistOptometric AssistantGroup - Single Specialty
No156FX1202XEye and Vision Services ProvidersTechnician/TechnologistOptometric TechnicianGroup - Single Specialty
No156FX1700XEye and Vision Services ProvidersTechnician/TechnologistOcularistGroup - Single Specialty
No156FX1900XEye and Vision Services ProvidersTechnician/TechnologistOrthoptistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0058092Medicare PIN