Provider Demographics
NPI:1366272114
Name:FERNANDEZ, SAMARA (OD)
Entity type:Individual
Prefix:DR
First Name:SAMARA
Middle Name:
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4454 SW 32ND RD APT 201
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-2135
Mailing Address - Country:US
Mailing Address - Phone:786-343-6954
Mailing Address - Fax:
Practice Address - Street 1:3581 SW ARCHER RD STE 20
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608-2428
Practice Address - Country:US
Practice Address - Phone:352-420-8724
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-06
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC6550152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist