Provider Demographics
NPI:1740331826
Name:FERNANDEZ, NIEVES M (OD)
Entity type:Individual
Prefix:DR
First Name:NIEVES
Middle Name:M
Last Name:FERNANDEZ
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 1:7225 BERGENLINE AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH BERGEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07047-5497
Mailing Address - Country:US
Mailing Address - Phone:201-861-8813
Mailing Address - Fax:201-861-2695
Practice Address - Street 1:7225 BERGENLINE AVE
Practice Address - Street 2:
Practice Address - City:NORTH BERGEN
Practice Address - State:NJ
Practice Address - Zip Code:07047-5497
Practice Address - Country:US
Practice Address - Phone:201-861-8813
Practice Address - Fax:201-861-2695
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJOA004255152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP408457OtherOXFORD HEALTH
NJ0511989OtherAETNA
NJT44526Medicare UPIN
NJP408457OtherOXFORD HEALTH