Provider Demographics
NPI:1811365190
Name:ORTIZ, ISAAC JACOB (OD)
Entity Type:Individual
Prefix:
First Name:ISAAC
Middle Name:JACOB
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 1:2112 LAPALCO AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89031-0607
Mailing Address - Country:US
Mailing Address - Phone:702-290-3414
Mailing Address - Fax:
Practice Address - Street 1:5115 CAMINO AL NORTE
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89031-2373
Practice Address - Country:US
Practice Address - Phone:702-358-0472
Practice Address - Fax:702-425-9955
Is Sole Proprietor?:No
Enumeration Date:2015-09-03
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV831152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist