Healthcare Provider Details

I. General information

NPI: 1720100217
Provider Name (Legal Business Name): RICHARD RENE ORTIZ O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 06/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9823 W IH 10
SAN ANTONIO TX
78230-2243
US

IV. Provider business mailing address

9823 W IH 10
SAN ANTONIO TX
78230-2243
US

V. Phone/Fax

Practice location:
  • Phone: 210-696-6500
  • Fax:
Mailing address:
  • Phone: 210-696-6500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3206T
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number3206T
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: