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General NPI Number Information
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NPI Number | 1578180147
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Entity Type | Organization
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Legal Business Name | ORTIZII PC
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Dates
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Enumeration Date | 06/30/2020
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Last Update Date | 06/30/2020
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Provider Practice Location Address
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Address Line | 111 N WABASH AVE STE 1111
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City | CHICAGO
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State | IL
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Zip | 60602-3119
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Country | US
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Telephone | 312-782-7833
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Fax | 312-236-0783
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Provider Business Mailing Address
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Address Line | 111 N WABASH AVE STE 1111
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City | CHICAGO
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State | IL
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Zip | 60602-3119
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Country | US
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Telephone | 312-782-7833
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Fax | 312-236-0783
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Authorized Official
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Title or Position | DOCTOR
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Name | BRIAN ORTIZ
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Credential | OD
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Telephone | 312-782-7833
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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 |
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License Number State |
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