Provider Demographics
NPI:1417030750
Name:ORTIZ-TORRES, CARLOS R (OD)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:R
Last Name:ORTIZ-TORRES
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:CARLOS
Other - Middle Name:R
Other - Last Name:ORTIZ-TORRES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:PO BOX 22740
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00931-2740
Mailing Address - Country:US
Mailing Address - Phone:787-966-7473
Mailing Address - Fax:787-945-2857
Practice Address - Street 1:400 CALLE BETANCES
Practice Address - Street 2:
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-5200
Practice Address - Country:US
Practice Address - Phone:787-653-2275
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR303152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRU76999Medicare UPIN