MEDICARE: HERNANDO ALFONSO OD

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	TUV004751-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	597303	OTHER	NY	USHC
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	P530098	OTHER	NY	OXFORD

General Provider Information

NPI Number	:	1871561134
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HERNANDO ALFONSO OD

Provider Business Mailing Address
First Line	:	1248 AVENUE U
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-4102
Country	:	US
Telephone Number	:	718-366-1213
Fax Number	:	718-672-9190

Provider Business Practice Location Address
First Line	:	1248 AVENUE U
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-4102
Country	:	US
Telephone Number	:	718-366-1213
Fax Number	:	718-672-9190

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

Provider Enumeration Date	:	03/10/2006
Last Update Date	:	01/29/2009

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