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General NPI Number Information
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NPI Number | 1518693100
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Entity Type | Individual
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Provider Name | EDGARDO LUIS ORTIZ GINES OD
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Gender | Male
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Dates
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Enumeration Date | 07/27/2022
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Last Update Date | 12/24/2024
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Provider Practice Location Address
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Address Line | RIO GRANDE TOWN CENTER CARR 3 SUITE A-19
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City | RIO GRANDE
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State | PR
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Zip | 00745
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Country | US
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Telephone | 787-988-7061
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Fax |
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Provider Business Mailing Address
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Address Line | CALLE 7F8 RINCON ESPANOL
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City | TRUJILLO ALTO
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State | PR
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Zip | 00976
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Country | US
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Telephone | 939-274-3911
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 756
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License Number State | PR
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