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General NPI Number Information
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NPI Number | 1285092833
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Entity Type | Organization
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Legal Business Name | ORTIZ OPTOMETRIC CARE
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Dates
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Enumeration Date | 02/10/2016
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Last Update Date | 01/18/2019
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Provider Practice Location Address
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Address Line | 8169 CALLE CONCORDIA CONDOMINIO SAN VICENTE OFICINA 204
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City | PONCE
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State | PR
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Zip | 00731
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Country | US
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Telephone | 787-412-7822
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 303
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City | MERCEDITA
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State | PR
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Zip | 00715-0303
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT / OPTOMETRIST
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Name | DR. JENNIFER ORTIZ MELENDEZ
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Credential | OD
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Telephone | 787-412-7822
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 684/0255
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License Number State | PR
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