Healthcare Provider Details

I. General information

NPI: 1689807265
Provider Name (Legal Business Name): CASSANDRA LEIGH ORTIZ O.D., M.S., F.A.A.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2009
Last Update Date: 07/06/2020
Certification Date: 07/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 ELIZABETH ST
OAK HILL WV
25901-2342
US

IV. Provider business mailing address

1001 ELIZABETH ST
OAK HILL WV
25901-2342
US

V. Phone/Fax

Practice location:
  • Phone: 304-465-0269
  • Fax: 304-465-1966
Mailing address:
  • Phone: 304-465-0269
  • Fax: 304-465-1966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1067-OD
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: