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General NPI Number Information
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NPI Number | 1780682641
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Entity Type | Individual
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Provider Name | KELVIN ORTIZ O.D.
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Gender | Male
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Dates
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Enumeration Date | 07/13/2005
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Last Update Date | 07/31/2019
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Provider Practice Location Address
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Address Line | 1 CALLE MCK JONES CENTRO VISUAL DR. KELVIN ORTIZ
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City | VILLALBA
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State | PR
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Zip | 00766-2228
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Country | US
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Telephone | 787-847-0091
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Fax | 787-847-0091
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Provider Business Mailing Address
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Address Line | PO BOX 1511
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City | VILLALBA
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State | PR
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Zip | 00766-1511
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Country | US
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Telephone | 787-847-0091
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Fax | 787-847-0091
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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 | 550
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License Number State | PR
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