Individual provider Active NPI

Herminio Fernandez, OPTICIAN

  • Optician
  • Woodside, NY
National Provider Identifier
1477704161
Registry record updated Oct 1, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
OpticianTaxonomy code 156FX1800X
License
006666 Issued in NY
Practice address
69-09 Roosevelt Avenue
Woodside, NY 11377
Phone
(718) 639-1392
NPI assigned
Oct 1, 2008
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 1, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optician 156FX1800X 006666 NY Primary

Addresses

Primary practice location

69-09 Roosevelt Avenue
Woodside, NY 11377

Mailing address

496 Dewey Avenue
Saddle Brook, NJ 07663
Phone (718) 639-1392

Other identifiers 4

IdentifierTypeStateIssuer
44101OtherDAVIS VISION
810546266MedicaidNY
919114OtherNYBLOCK VISION
02291789MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
006666NYMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Eyellusion Vision Center Incorporated Optician Current Accepting new patients
Eye Q Optical Inc. Current Accepting new patients
Eyellusion Vision Center Incorporated Optician Current Accepting new patients

Locations

6909 Roosevelt Ave
Woodside, NY 11377
Phone (718) 639-1392

Organizations & group practices 3

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": "1222819200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1222819200000",
    "number": "1477704161",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "496 DEWEY AVENUE",
            "city": "SADDLE BROOK",
            "state": "NJ",
            "postal_code": "07663",
            "telephone_number": "718-639-1392",
            "fax_number": "718-639-2041"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "69-09 ROOSEVELT AVENUE",
            "city": "WOODSIDE",
            "state": "NY",
            "postal_code": "11377",
            "telephone_number": "718-639-1392"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FERNANDEZ",
        "first_name": "HERMINIO",
        "name_prefix": "Mr.",
        "credential": "OPTICIAN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-10-01",
        "last_updated": "2008-10-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "156FX1800X",
            "taxonomy_group": "",
            "desc": "Technician/Technologist, Optician",
            "state": "NY",
            "license": "006666",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DAVIS VISION",
            "identifier": "44101",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "810546266",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLOCK VISION",
            "identifier": "919114",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02291789",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Woodside, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.