Provider Demographics
NPI:1396954533
Name:HERMAN L DE ANNA OD PA
Entity type:Organization
Organization Name:HERMAN L DE ANNA OD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HERMAN
Authorized Official - Middle Name:LEONEL
Authorized Official - Last Name:DE ANNA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:305-992-2290
Mailing Address - Street 1:7100 W 20 AVE
Mailing Address - Street 2:SUITE 702
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-1824
Mailing Address - Country:US
Mailing Address - Phone:305-825-3005
Mailing Address - Fax:305-819-5887
Practice Address - Street 1:7100 W 20 AVE
Practice Address - Street 2:SUITE 702
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-1824
Practice Address - Country:US
Practice Address - Phone:305-825-3005
Practice Address - Fax:305-819-5887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC2749152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL620097400Medicaid
FLP00100900OtherRAILROAD MEDICARE
FLU52774Medicare UPIN
FL20539Medicare ID - Type Unspecified
FL620097400Medicaid