Provider Demographics
NPI:1447229521
Name:TORT, WANDA M (OD)
Entity Type:Individual
Prefix:DR
First Name:WANDA
Middle Name:M
Last Name:TORT
Suffix:
Gender:F
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:EXT. HNAS DAVILA
Mailing Address - Street 2:J12-A CALLE 2
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00959-5001
Mailing Address - Country:US
Mailing Address - Phone:787-780-0677
Mailing Address - Fax:787-740-5070
Practice Address - Street 1:EXT. HNAS DAVILA
Practice Address - Street 2:J12-A CALLE 2
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959-5001
Practice Address - Country:US
Practice Address - Phone:787-780-0677
Practice Address - Fax:787-740-5070
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR143152W00000X, 152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered152W00000XEye and Vision Services ProvidersOptometrist
Not Answered152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR#U-17027Medicare UPIN