Provider Demographics
NPI:1669004024
Name:DRS. EDWARD P. AND DIANE M. HERNANDEZ, O.D.
Entity Type:Organization
Organization Name:DRS. EDWARD P. AND DIANE M. HERNANDEZ, O.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:WONER
Authorized Official - Prefix:DR
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:MOSSER
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:626-391-2021
Mailing Address - Street 1:6001 PACIFIC BLVD STE 128
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90255-2950
Mailing Address - Country:US
Mailing Address - Phone:323-923-9001
Mailing Address - Fax:323-923-9345
Practice Address - Street 1:6001 PACIFIC BLVD STE 128
Practice Address - Street 2:
Practice Address - City:HUNTINGTON PARK
Practice Address - State:CA
Practice Address - Zip Code:90255-2950
Practice Address - Country:US
Practice Address - Phone:323-923-9001
Practice Address - Fax:323-923-9345
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DRS. EDWARD P. AND DIANE M. HERNANDEZ, O.D.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-02-04
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty