MEDICARE: DR. JOHN MANUEL HERNANDEZ O.D.

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	OPT 7216	CA

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	190545	OTHER	CA	SAFEGUARD VISION
2	3235893381	OTHER	CA	VISION SERVICE PLAN
3	903261	OTHER	CA	BLOCK VISION, INC.
4	1535	OTHER	CA	CARE FIRST
5	NONE	OTHER	CA	THREE RIVERS PROVIDER NET
6	165	OTHER	CA	VISION PLAN OF AMERICA
7	3351	OTHER	CA	MEDICAL EYE SERVICES/ECN
8	NONE	OTHER	CA	ADVANTAGE HEALTH NETWORK
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
10	CA 7216	OTHER	CA	ECPA/EYEMED
11	NONE	OTHER	CA	SOUTH ATLANTIC MEDICAL GR

NPI Number	:	1114954856
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN MANUEL HERNANDEZ O.D.

Provider Business Mailing Address
First Line	:	6134 PACIFIC BLVD
Second Line	:
City	:	HUNTINGTON PARK
State	:	CA
Zip	:	90255-2923
Country	:	US
Telephone Number	:	323-589-3381
Fax Number	:	323-583-6439

Provider Business Practice Location Address
First Line	:	6134 PACIFIC BLVD
Second Line	:
City	:	HUNTINGTON PARK
State	:	CA
Zip	:	90255-2923
Country	:	US
Telephone Number	:	323-589-3381
Fax Number	:	323-583-6439

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/27/2006
Last Update Date	:	06/14/2011

6134 PACIFIC BLVD
HUNTINGTON PARK, CA
90255-2923

Practice Phone: 323-589-3381
Practice Fax: 323-583-6439