Provider Demographics
NPI:1508874942
Name:HERNANDEZ, JEROME M (OD)
Entity Type:Individual
Prefix:
First Name:JEROME
Middle Name:M
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7400 N KENDALL DR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156-7706
Mailing Address - Country:US
Mailing Address - Phone:305-670-6060
Mailing Address - Fax:305-670-0678
Practice Address - Street 1:7400 N KENDALL DR
Practice Address - Street 2:SUITE 110
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33156-7706
Practice Address - Country:US
Practice Address - Phone:305-670-6060
Practice Address - Fax:305-670-0678
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2010-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOP 2362152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL078969100Medicaid
FL20389XMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
FL078969100Medicaid