Provider Demographics
NPI:1598298531
Name:HERNANDEZ - REYES, CARLOS EDUARDO (LICENSED OPTICIAN)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:EDUARDO
Last Name:HERNANDEZ - REYES
Suffix:
Gender:M
Credentials:LICENSED OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1571 SAINT NICHOLAS AVE
Mailing Address - Street 2:GROUND
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10040-4261
Mailing Address - Country:US
Mailing Address - Phone:212-543-3937
Mailing Address - Fax:212-543-3932
Practice Address - Street 1:1571 SAINT NICHOLAS AVE
Practice Address - Street 2:GROUND
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10040-4261
Practice Address - Country:US
Practice Address - Phone:212-543-3937
Practice Address - Fax:212-543-3932
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-06
Last Update Date:2017-05-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY008564-1156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician