Provider Demographics
NPI:1538142914
Name:HESS, CARMEN R (OD)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:R
Last Name:HESS
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:BALDORIOTY 64
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:PR
Mailing Address - Zip Code:00751
Mailing Address - Country:US
Mailing Address - Phone:787-824-4111
Mailing Address - Fax:787-824-4111
Practice Address - Street 1:BALDORIOTY 64
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:PR
Practice Address - Zip Code:00751
Practice Address - Country:US
Practice Address - Phone:787-824-4111
Practice Address - Fax:787-824-4111
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRH255152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MMM890193Medicare ID - Type Unspecified
58112Medicare ID - Type Unspecified
U42510Medicare UPIN