MEDICARE: DR. MADELINE HERNANDEZ O.D.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	OPC3590	FL
2	152WC0802X	Corneal and Contact Management Optometrist	OPC3590	FL
3	152WS0006X	Sports Vision Optometrist	OPC3590	FL
4	152WV0400X	Vision Therapy Optometrist	OPC3590	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1710907944
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MADELINE HERNANDEZ O.D.

Provider Business Mailing Address
First Line	:	5607 JOHNS RD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33634-4499
Country	:	US
Telephone Number	:	813-885-3937
Fax Number	:

Provider Business Practice Location Address
First Line	:	1510 E FOWLER AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33612-5416
Country	:	US
Telephone Number	:	813-971-0471
Fax Number	:	813-464-2763

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

Provider Enumeration Date	:	07/20/2006
Last Update Date	:	03/29/2018

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Directions to “ DR. MADELINE HERNANDEZ O.D.” Practice Location

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