MEDICARE: DR. KELVIN ORTIZ O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	550	PR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	101155	OTHER	PR	IVISION
2	890097	OTHER	PR	MMM
3	9402	OTHER	PR	IMC
4	550	OTHER	PR	CPO
5	215136	OTHER	PR	PREFERRED
6	4671190001	OTHER	PR	PALMETTO GBA
7	077165	OTHER	PR	BLUE CROSS
8	2200117	OTHER	PR	HUMANA
9	62169	OTHER	PR	TRIPLE-S
10	020637024	OTHER	PR	MCS

General Provider Information

NPI Number	:	1780682641
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KELVIN ORTIZ O.D.

Provider Business Mailing Address
First Line	:	PO BOX 1511
Second Line	:
City	:	VILLALBA
State	:	PR
Zip	:	00766-1511
Country	:	US
Telephone Number	:	787-847-0091
Fax Number	:	787-847-0091

Provider Business Practice Location Address
First Line	:	1 CALLE MCK JONES
Second Line	:	CENTRO VISUAL DR. KELVIN ORTIZ
City	:	VILLALBA
State	:	PR
Zip	:	00766-2228
Country	:	US
Telephone Number	:	787-847-0091
Fax Number	:	787-847-0091

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/13/2005
Last Update Date	:	07/31/2019

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