Provider Demographics
NPI:1689807265
Name:ORTIZ, CASSANDRA LEIGH (OD, MS, FAAO)
Entity Type:Individual
Prefix:DR
First Name:CASSANDRA
Middle Name:LEIGH
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:OD, MS, FAAO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 ELIZABETH ST
Mailing Address - Street 2:
Mailing Address - City:OAK HILL
Mailing Address - State:WV
Mailing Address - Zip Code:25901-2342
Mailing Address - Country:US
Mailing Address - Phone:304-465-0269
Mailing Address - Fax:304-465-1966
Practice Address - Street 1:1001 ELIZABETH ST
Practice Address - Street 2:
Practice Address - City:OAK HILL
Practice Address - State:WV
Practice Address - Zip Code:25901-2342
Practice Address - Country:US
Practice Address - Phone:304-465-0269
Practice Address - Fax:304-465-1966
Is Sole Proprietor?:No
Enumeration Date:2009-08-28
Last Update Date:2020-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1067-OD152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist