Provider Demographics
NPI:1184404808
Name:PAZ HERNANDEZ, HUGO
Entity type:Individual
Prefix:
First Name:HUGO
Middle Name:
Last Name:PAZ HERNANDEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8437 LANEWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:LEEDS
Mailing Address - State:AL
Mailing Address - Zip Code:35094-7905
Mailing Address - Country:US
Mailing Address - Phone:205-613-6856
Mailing Address - Fax:
Practice Address - Street 1:1851 CHRISTOPHER COLUMBUS BLVD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19148-2800
Practice Address - Country:US
Practice Address - Phone:215-717-4101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-02
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG004077152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist