Provider Demographics
NPI:1770792954
Name:JORGE W. MENDEZ ORTIZ
Entity type:Organization
Organization Name:JORGE W. MENDEZ ORTIZ
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILSON
Authorized Official - Middle Name:
Authorized Official - Last Name:MENDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:OPTICIAN
Authorized Official - Phone:787-854-9300
Mailing Address - Street 1:PO BOX 851
Mailing Address - Street 2:
Mailing Address - City:MANATI
Mailing Address - State:PR
Mailing Address - Zip Code:00674-0851
Mailing Address - Country:US
Mailing Address - Phone:787-854-6639
Mailing Address - Fax:787-884-5240
Practice Address - Street 1:CARR #2 KM 47.0 SECTOR CAMPO ALEGRE
Practice Address - Street 2:
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674-5414
Practice Address - Country:US
Practice Address - Phone:787-854-6639
Practice Address - Fax:787-884-5240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2013-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty