Individual
DR. MADELINE HERNANDEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
1510 E FOWLER AVE, TAMPA, FL 33612-5416
(813) 971-0471
(813) 464-2763
Mailing address
5607 JOHNS RD, TAMPA, FL 33634-4499
(813) 885-3937
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OPC3590
FL
152WC0802X
Corneal and Contact Management Optometrist
OPC3590
FL
152WS0006X
Sports Vision Optometrist
OPC3590
FL
152WV0400X
Vision Therapy Optometrist
OPC3590
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
620915700
—
FL
Enumeration date
07/20/2006
Last updated
03/29/2018
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