Individual provider Active NPI

Herman L Deanna, OD

  • Optometrist
  • Hialeah, FL
National Provider Identifier
1245204502
Registry record updated Jan 21, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OPC2749 Issued in FL
Practice address
7100 W 20TH Ave Ste 702
Hialeah, FL 33016-1824
Phone
(305) 825-3005
Fax
(305) 819-5887
NPI assigned
Feb 14, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 21, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X OPC2749 FL Primary

Addresses

Primary practice location

7100 W 20TH Ave Ste 702
Hialeah, FL 33016-1824

Mailing address

7100 W 20TH Ave Ste 702
Hialeah, FL 33016-1824
Phone (305) 825-3005

Other identifiers 3

IdentifierTypeStateIssuer
620097400MedicaidFL
5723570OtherFLAETNA PIN
810468OtherFLEYEMED PIN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060407000147 FL Practitioner - Optometry 0840209540 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Herman L de Anna OD PA Optometrist CurrentSince Oct 1, 2007 Accepting new patients

Locations

1625 W 49th St
Hialeah, FL 33012
Phone (305) 364-3879

7100 W 20th Ave
Ste 702
Hialeah, FL 33016
Phone (305) 825-3005

7100 W 20th Ave
Ste 315
Hialeah, FL 33016
Phone (305) 557-6201

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1139875200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705795200000",
    "number": "1245204502",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7100 W 20TH AVE STE 702",
            "city": "HIALEAH",
            "state": "FL",
            "postal_code": "330161824",
            "telephone_number": "305-825-3005",
            "fax_number": "305-819-5887"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7100 W 20TH AVE STE 702",
            "city": "HIALEAH",
            "state": "FL",
            "postal_code": "330161824",
            "telephone_number": "305-825-3005",
            "fax_number": "305-819-5887"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEANNA",
        "first_name": "HERMAN",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-14",
        "last_updated": "2024-01-21",
        "certification_date": "2024-01-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "FL",
            "license": "OPC2749",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "620097400",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA PIN",
            "identifier": "5723570",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EYEMED PIN",
            "identifier": "810468",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hialeah, FL

Sources for this page

Verify at the official NPI Registry.