Provider Demographics
NPI:1467418376
Name:ORTIZ WHATTS, LUIS A (OD)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:A
Last Name:ORTIZ WHATTS
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 128
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00960-0128
Mailing Address - Country:US
Mailing Address - Phone:787-787-0732
Mailing Address - Fax:787-785-5848
Practice Address - Street 1:73 CALLE DR VEVE
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-6344
Practice Address - Country:US
Practice Address - Phone:787-787-0732
Practice Address - Fax:787-785-5848
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-21
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR91152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR077051OtherLA CRUZ AZUL DE PR
PR660290574OtherMMM HEALTHCARE
PR215063OtherPREFERRED HEALTH PLAN
PR0910OtherINTERNATIONAL MEDICAL CAR
PRT-26847Medicare UPIN
PR54171Medicare PIN
PR215063OtherPREFERRED HEALTH PLAN