Healthcare Provider Details

I. General information

NPI: 1780682641
Provider Name (Legal Business Name): KELVIN ORTIZ O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2005
Last Update Date: 07/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CALLE MCK JONES CENTRO VISUAL DR. KELVIN ORTIZ
VILLALBA PR
00766-2228
US

IV. Provider business mailing address

PO BOX 1511
VILLALBA PR
00766-1511
US

V. Phone/Fax

Practice location:
  • Phone: 787-847-0091
  • Fax: 787-847-0091
Mailing address:
  • Phone: 787-847-0091
  • Fax: 787-847-0091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number550
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: