NPIMap

Organization Active NPI

DRS. Edward P. and Diane M. Hernandez, O.D.

  • Optometrist
  • Duarte, CA
National Provider Identifier
1619186848
Registry record updated Mar 19, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
08738T Issued in CA
Legal business name
DRS. EDWARD P. AND DIANE M. HERNANDEZ, O.D.
Doing business as
Drs. Edward P. and Diane M. Hernandez, O.D.
Practice address
1235 Buena Vista St
Duarte, CA 91010-2408
Phone
(626) 359-8145
Fax
(626) 359-4116
NPI assigned
May 22, 2007
Last updated
Mar 19, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 19, 2014

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

Authorized official

Name
Dr. Diane Mosser Hernandez, O.D.NPI 1326108747
Title
Owner
Phone
(626) 359-8145

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X 08738T CA Primary

Addresses

Primary practice location

1235 Buena Vista St
Duarte, CA 91010-2408

Mailing address

1235 Buena Vista St
Duarte, CA 91010-2408
Phone (626) 359-8145

Other identifiers 1

IdentifierTypeStateIssuer
GSD005310MedicaidCA

Other names 1

  • Drs. Edward P. and Diane M. Hernandez, O.D. Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050606001144 CA Part B Supplier - Clinic/Group Practice 3870536303 Receives reassigned benefits from 10 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: La Puente, CA; Duarte, CA

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Edward P Diane M Hernand2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1235 Buena Vista St
Duarte, CA 91010
Phone (626) 359-8145

15530 Amar Rd Ste a
La Puente, CA 91744
Phone (626) 961-0432

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1179792000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1395187200000",
    "number": "1619186848",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1235 BUENA VISTA ST",
            "city": "DUARTE",
            "state": "CA",
            "postal_code": "910102408",
            "telephone_number": "626-359-8145",
            "fax_number": "626-359-4116"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1235 BUENA VISTA ST",
            "city": "DUARTE",
            "state": "CA",
            "postal_code": "910102408",
            "telephone_number": "626-359-8145",
            "fax_number": "626-359-4116"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DRS. EDWARD P. AND DIANE M. HERNANDEZ, O.D.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-22",
        "last_updated": "2014-03-19",
        "status": "A",
        "authorized_official_last_name": "HERNANDEZ",
        "authorized_official_first_name": "DIANE",
        "authorized_official_middle_name": "MOSSER",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "626-359-8145",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "CA",
            "license": "08738T",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GSD005310",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Drs. Edward P. and Diane M. Hernandez, O.D.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Duarte, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.