Provider Demographics
NPI:1407006141
Name:ORTIZ, ROLANDO (OD)
Entity Type:Individual
Prefix:DR
First Name:ROLANDO
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:PO BOX 1356
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560-1356
Mailing Address - Country:US
Mailing Address - Phone:787-538-9686
Mailing Address - Fax:
Practice Address - Street 1:836 E CHATHAM ST STE 106
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-6967
Practice Address - Country:US
Practice Address - Phone:919-755-3444
Practice Address - Fax:919-755-3424
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-30
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR652152W00000X
NC2186152W00000X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist