Healthcare Provider Details

I. General information

NPI: 1497680680
Provider Name (Legal Business Name): OLGA LIZETH HERNANDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1353 DORCHESTER AVE
DORCHESTER MA
02122-2932
US

IV. Provider business mailing address

55 BROADWAY
LYNN MA
01904-1858
US

V. Phone/Fax

Practice location:
  • Phone: 617-288-3230
  • Fax:
Mailing address:
  • Phone: 781-228-9920
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT8417
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: