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General NPI Number Information
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NPI Number | 1801070602
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Entity Type | Organization
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Legal Business Name | REYNA HERNANDEZ OD PA
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Dates
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Enumeration Date | 12/28/2007
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Last Update Date | 10/29/2012
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Provider Practice Location Address
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Address Line | 3385 NAAMAN SCHOOL RD
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City | GARLAND
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State | TX
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Zip | 75040-8717
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Country | US
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Telephone | 972-496-2020
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Fax | 972-414-0912
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Provider Business Mailing Address
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Address Line | 3385 NAAMAN SCHOOL RD
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City | GARLAND
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State | TX
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Zip | 75040-8717
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Country | US
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Telephone | 972-496-2020
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Fax | 972-414-0912
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Authorized Official
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Title or Position | OWNER
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Name | REYNA HERNANDEZ
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Credential | O.D.
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Telephone | 972-496-2020
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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 | 5249TG
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License Number State | TX
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