Provider Demographics
NPI:1568685923
Name:ORTIZ EYE ASSOCIATES, P. C.
Entity Type:Organization
Organization Name:ORTIZ EYE ASSOCIATES, P. C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:P
Authorized Official - Last Name:ORTIZ
Authorized Official - Suffix:
Authorized Official - Credentials:O D
Authorized Official - Phone:815-942-5500
Mailing Address - Street 1:880 BEDFORD RD
Mailing Address - Street 2:
Mailing Address - City:MORRIS
Mailing Address - State:IL
Mailing Address - Zip Code:60450-1209
Mailing Address - Country:US
Mailing Address - Phone:815-942-5500
Mailing Address - Fax:815-942-1851
Practice Address - Street 1:880 BEDFORD RD
Practice Address - Street 2:
Practice Address - City:MORRIS
Practice Address - State:IL
Practice Address - Zip Code:60450-1209
Practice Address - Country:US
Practice Address - Phone:815-942-5500
Practice Address - Fax:815-942-1851
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2010-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046008365152W00000X
IL046006070152W00000X
IL046008832152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL046006070Medicaid
IL046008832Medicaid
IL046008365Medicaid
IL046008365Medicaid
IL046008832Medicaid
IL922400Medicare ID - Type UnspecifiedANGELO MARINO
ILU58266Medicare UPIN
ILU 17583Medicare UPIN
ILT 35329Medicare UPIN
IL922400Medicare ID - Type UnspecifiedTIMOTHY P. ORTIZ