Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1700X | Ocularist |
NPI | 1164739686 |
---|---|
Provider Name | David C Hernandez |
First Address | Indiana, PA 15701-1869 |
Second Address | Indiana, PA 15701-1869 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/09/2010 |
Last Update Date | 12/11/2010 |