MEDICARE: CENTRO VISUAL DR KELVIN ORTIZ PSC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM2500X	Medical Specialty Clinic/Center	550	PR

General Provider Information

NPI Number	:	1255752960
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTRO VISUAL DR KELVIN ORTIZ PSC

Provider Business Mailing Address
First Line	:	PO BOX 1511
Second Line	:
City	:	VILLALBA
State	:	PR
Zip	:	00766-1511
Country	:	US
Telephone Number	:	787-847-0091
Fax Number	:	787-847-0091

Provider Business Practice Location Address
First Line	:	1 CALLE MCK JONES
Second Line	:
City	:	VILLALBA
State	:	PR
Zip	:	00766-2228
Country	:	US
Telephone Number	:	787-847-0091
Fax Number	:	787-847-0091

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. KELVIN ORTIZ
Credential	:	O.D.
Telephone Number	:	787-847-0091

Provider Enumeration Date	:	12/23/2013
Last Update Date	:	02/17/2015

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