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General NPI Number Information
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NPI Number | 1760789440
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Entity Type | Organization
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Legal Business Name | JEROME HERNANDEZ, OD, INC.
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Dates
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Enumeration Date | 02/16/2011
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Last Update Date | 09/14/2012
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Provider Practice Location Address
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Address Line | 7400 N KENDALL DR SUITE 110
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City | MIAMI
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State | FL
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Zip | 33156-7706
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Country | US
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Telephone | 305-670-6060
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Fax | 305-670-0678
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Provider Business Mailing Address
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Address Line | 7400 N KENDALL DR SUITE 110
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City | MIAMI
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State | FL
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Zip | 33156-7706
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Country | US
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Telephone | 305-670-6060
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Fax | 305-670-0678
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Authorized Official
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Title or Position | PRESIDENT
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Name | JEROME HERNANDEZ
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Credential | O.D.
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Telephone | 305-670-6060
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPC2362
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License Number State | FL
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