Provider Demographics
NPI:1134185986
Name:HERNANDEZ, SYLVIA (OD)
Entity type:Individual
Prefix:DR
First Name:SYLVIA
Middle Name:
Last Name:HERNANDEZ
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 1:280 CONCORD PKWY S
Mailing Address - Street 2:SUITE 110-C
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-6730
Mailing Address - Country:US
Mailing Address - Phone:704-788-1975
Mailing Address - Fax:704-788-1976
Practice Address - Street 1:280 CONCORD PKWY S
Practice Address - Street 2:SUITE 110-C
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28027-6730
Practice Address - Country:US
Practice Address - Phone:704-788-1975
Practice Address - Fax:704-788-1976
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2009-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1842152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5901648Medicaid
NC5901648Medicaid
NC2473772Medicare ID - Type UnspecifiedINDIVIDUAL NUMBER
NC2348610Medicare ID - Type UnspecifiedGROUP NUMBER