Provider Demographics
NPI:1467670935
Name:ORTIZ, WILLIAM (BCO)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:ORTIZ
Suffix:
Gender:M
Credentials:BCO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 CALLE AGUAS BUENAS
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00727-4947
Mailing Address - Country:US
Mailing Address - Phone:787-745-2040
Mailing Address - Fax:787-745-2040
Practice Address - Street 1:AVE DEGETAU #II-1
Practice Address - Street 2:BONNEVILLE HEIGHTS
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-745-2040
Practice Address - Fax:787-745-2040
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1700XEye and Vision Services ProvidersTechnician/TechnologistOcularist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1087960001Medicare ID - Type UnspecifiedPNI