Provider Demographics
NPI:1366125742
Name:HERNANDEZ, CHRISTIAN DANIEL (OD)
Entity type:Individual
Prefix:DR
First Name:CHRISTIAN
Middle Name:DANIEL
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1091 TULIP LN
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-5755
Mailing Address - Country:US
Mailing Address - Phone:708-710-9141
Mailing Address - Fax:
Practice Address - Street 1:1513 W LANE RD
Practice Address - Street 2:
Practice Address - City:MACHESNEY PARK
Practice Address - State:IL
Practice Address - Zip Code:61115-1902
Practice Address - Country:US
Practice Address - Phone:779-238-5851
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-10
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL346004370152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist