Provider Demographics
NPI:1619089794
Name:FERNANDEZ, ANNA MARIE (OD)
Entity Type:Individual
Prefix:DR
First Name:ANNA MARIE
Middle Name:
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 1:2655 RICHMOND AVE STE 114
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-5821
Mailing Address - Country:US
Mailing Address - Phone:718-761-5607
Mailing Address - Fax:718-761-5452
Practice Address - Street 1:2655 RICHMOND AVE STE 114
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314
Practice Address - Country:US
Practice Address - Phone:718-761-5607
Practice Address - Fax:718-761-5452
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2018-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV004573152W00000X
NYTUV0045731152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400010214Medicare PIN