MEDICARE: DR. ANGEL L ALICEA ORTIZ O.D.

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	152W00000X	Optometrist	0583	PR
2	152W00000X	Optometrist	583	PR

General Provider Information

NPI Number	:	1598837007
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANGEL L ALICEA ORTIZ O.D.

Provider Business Mailing Address
First Line	:	CALLE ISABEL #223 MANSION REAL
Second Line	:
City	:	COTO LAUREL
State	:	PR
Zip	:	00780
Country	:	US
Telephone Number	:	787-840-4646
Fax Number	:	787-840-4646

Provider Business Practice Location Address
First Line	:	1718 CARR. 506 MARGINAL
Second Line	:	SUITE 101
City	:	COTO LAUREL
State	:	PR
Zip	:	00780-2948
Country	:	US
Telephone Number	:	787-840-4646
Fax Number	:	787-840-4646

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/14/2006
Last Update Date	:	09/30/2022

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