Provider Demographics
NPI:1225252521
Name:SALAS-HERNANDEZ, JOANNETTE (OD)
Entity Type:Individual
Prefix:
First Name:JOANNETTE
Middle Name:
Last Name:SALAS-HERNANDEZ
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 1:789 SENECA MEADOWS ROAD
Mailing Address - Street 2:
Mailing Address - City:WINTER SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32708
Mailing Address - Country:US
Mailing Address - Phone:407-346-0091
Mailing Address - Fax:407-332-0644
Practice Address - Street 1:789 SENECA MEADOWS RD
Practice Address - Street 2:
Practice Address - City:WINTER SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32708
Practice Address - Country:US
Practice Address - Phone:407-346-0091
Practice Address - Fax:407-332-0644
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2018-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC3633152W00000X
FL3633152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist