Provider Demographics
NPI:1780682641
Name:ORTIZ, KELVIN (OD)
Entity Type:Individual
Prefix:DR
First Name:KELVIN
Middle Name:
Last Name:ORTIZ
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 1511
Mailing Address - Street 2:
Mailing Address - City:VILLALBA
Mailing Address - State:PR
Mailing Address - Zip Code:00766-1511
Mailing Address - Country:US
Mailing Address - Phone:787-847-0091
Mailing Address - Fax:787-847-0091
Practice Address - Street 1:1 CALLE MCK JONES
Practice Address - Street 2:CENTRO VISUAL DR. KELVIN ORTIZ
Practice Address - City:VILLALBA
Practice Address - State:PR
Practice Address - Zip Code:00766-2228
Practice Address - Country:US
Practice Address - Phone:787-847-0091
Practice Address - Fax:787-847-0091
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-13
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR550152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR101155OtherIVISION
PR890097OtherMMM
PR9402OtherIMC
PR550OtherCPO
PR215136OtherPREFERRED
PR4671190001OtherPALMETTO GBA
PR077165OtherBLUE CROSS
PR2200117OtherHUMANA
PR62169OtherTRIPLE-S
PR020637024OtherMCS
PR4671190001OtherPALMETTO GBA