Provider Demographics
NPI:1760789440
Name:JEROME HERNANDEZ, OD, INC.
Entity Type:Organization
Organization Name:JEROME HERNANDEZ, OD, INC.
Other - Org Name:KENDALL OPTICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEROME
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:305-670-6060
Mailing Address - Street 1:7400 N KENDALL DR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156-7706
Mailing Address - Country:US
Mailing Address - Phone:305-670-6060
Mailing Address - Fax:305-670-0678
Practice Address - Street 1:7400 N KENDALL DR
Practice Address - Street 2:SUITE 110
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33156-7706
Practice Address - Country:US
Practice Address - Phone:305-670-6060
Practice Address - Fax:305-670-0678
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-16
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC2362152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL078969100Medicaid
FL078969100Medicaid