Healthcare Provider Details

I. General information

NPI: 1548547516
Provider Name (Legal Business Name): MR. ABEL HERNANDEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: TRACY C AARONS

II. Dates (important events)

Enumeration Date: 11/04/2011
Last Update Date: 04/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2220 MARTIN LUTHER KING JR BLVD
ANACOSTIA DC
20020
US

IV. Provider business mailing address

5026 ROUNTOWER PLACE
COLUMBIA MD
21044
US

V. Phone/Fax

Practice location:
  • Phone: 203-892-2545
  • Fax:
Mailing address:
  • Phone: 203-892-2545
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code156FC0800X
TaxonomyContact Lens Technician/Technologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: