Provider Demographics
NPI:1083703052
Name:LUGO ORTIZ, LUIS ALBERTO (OD)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:ALBERTO
Last Name:LUGO ORTIZ
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 CAMINO DE LA LOMA
Mailing Address - Street 2:SABANERA
Mailing Address - City:CIDRA
Mailing Address - State:PR
Mailing Address - Zip Code:00739-9480
Mailing Address - Country:US
Mailing Address - Phone:787-385-8161
Mailing Address - Fax:
Practice Address - Street 1:PASEO GAUTIER BENITEZ 16
Practice Address - Street 2:GALERIA MUNIZ SUITE 11
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-744-4020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR298152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR9200061OtherHUMANA
PR660-40-2309OtherMAFPRE MEDICARE EXCEL
PR890258OtherMEDICARE Y MUCHO MAS
PR58236OtherTRIPLE S
PR660-49-8211OtherMCS OPTICA
PRPR0298OtherEYEMED
PR215096OtherPREFERRED HEALTH
PR660-40-2309OtherMAFPRE MEDICARE EXCEL
PR0058236Medicare ID - Type UnspecifiedMEDICARE
PR068-298OtherGLOBAL HEALTH
PR0058236Medicare ID - Type UnspecifiedMEDICARE
PR00097OtherVISION HEMISFERICA
PR31175OtherPROSSAM
PR660-40-2309OtherMAFPRE MEDICARE EXCEL
PR10-0667OtherLA CRUZ AZUL