Individual
DIANA CATALINA HERNANDEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
964 S WICKHAM RD STE 1, WEST MELBOURNE, FL 32904-1460
(321) 339-2211
(321) 339-1183
Mailing address
964 S WICKHAM RD, WEST MELBOURNE, FL 32904-1460
(321) 339-2211
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
OEG002112
PA
152W00000X
Optometrist
Primary
OPC 4308
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001652100
—
FL
01
—
1901V
BCBS
FL
Enumeration date
06/06/2008
Last updated
10/28/2019
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