Provider Demographics
NPI:1750322368
Name:HERMIDA, RAYMOND AMADO (OD)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:AMADO
Last Name:HERMIDA
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 1:2229 W NEW HAVEN AVE
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32904-3805
Mailing Address - Country:US
Mailing Address - Phone:321-726-6551
Mailing Address - Fax:321-726-0443
Practice Address - Street 1:2229 W NEW HAVEN AVE
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32904-3805
Practice Address - Country:US
Practice Address - Phone:321-726-6551
Practice Address - Fax:321-726-0443
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC2898152W00000X, 152WC0802X
FLOB2475152WS0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WS0006XEye and Vision Services ProvidersOptometristSports Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL620265900Medicaid
FLOE512001Medicare PIN
FLU63396Medicare UPIN