Provider Demographics
NPI:1215182563
Name:ORTIZ, OSCAR (OD)
Entity Type:Individual
Prefix:DR
First Name:OSCAR
Middle Name:
Last Name:ORTIZ
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8135 BROADMOOR ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53719-4465
Mailing Address - Country:US
Mailing Address - Phone:571-277-1422
Mailing Address - Fax:
Practice Address - Street 1:1 W TOWNE MALL
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719-1019
Practice Address - Country:US
Practice Address - Phone:608-829-2440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-28
Last Update Date:2008-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3127-035152WC0802X
VA0618001789152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management