Provider Demographics
NPI:1326061656
Name:FERNANDEZ, LISA ANDRES (OD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:ANDRES
Last Name:FERNANDEZ
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 1:1516 SUMMIT AVE
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07087-1949
Mailing Address - Country:US
Mailing Address - Phone:201-974-0401
Mailing Address - Fax:201-974-0401
Practice Address - Street 1:1516 SUMMIT AVE
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:NJ
Practice Address - Zip Code:07087-1949
Practice Address - Country:US
Practice Address - Phone:201-974-0401
Practice Address - Fax:201-974-0401
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2009-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27TO00127700152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDP00260747OtherMEDICARE RAILROAD
MA0708674Medicaid
MAW16426OtherBLUE CROSS BLUE SHIELD
MAW17592Medicare ID - Type Unspecified
U98409Medicare UPIN