Provider Demographics
NPI:1639261936
Name:ORTIZ, EVELYN (OPTOMETRIST)
Entity Type:Individual
Prefix:DR
First Name:EVELYN
Middle Name:
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:OPTOMETRIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB. SABANERA DEL RIO 388 CAMINO DE LOS SAUCES
Mailing Address - Street 2:
Mailing Address - City:GURABO
Mailing Address - State:PR
Mailing Address - Zip Code:00778-5254
Mailing Address - Country:US
Mailing Address - Phone:787-640-6716
Mailing Address - Fax:
Practice Address - Street 1:45 CALLE RUIZ BELVIS
Practice Address - Street 2:
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-3552
Practice Address - Country:US
Practice Address - Phone:787-743-5785
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR355152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist