Provider Demographics
NPI:1720100217
Name:ORTIZ, RICHARD RENE (OD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:RENE
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 1:9823 W IH 10
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-2243
Mailing Address - Country:US
Mailing Address - Phone:210-696-6500
Mailing Address - Fax:
Practice Address - Street 1:9823 W IH 10
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-2243
Practice Address - Country:US
Practice Address - Phone:210-696-6500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3206T152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXT91281Medicare UPIN
TX8F1979Medicare PIN
8F1979Medicare ID - Type UnspecifiedPROVIDER NUMBER