Provider Demographics
NPI:1881370724
Name:ORTIZ, JENNIFER MELISSA (LDO)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MELISSA
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:555 HUBBARD AVENUE
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201
Mailing Address - Country:US
Mailing Address - Phone:413-442-2734
Mailing Address - Fax:413-442-2811
Practice Address - Street 1:555 HUBBARD AVENUE PITTSFIELD
Practice Address - Street 2:
Practice Address - City:MA
Practice Address - State:MA
Practice Address - Zip Code:01201
Practice Address - Country:US
Practice Address - Phone:413-442-2734
Practice Address - Fax:413-442-2811
Is Sole Proprietor?:No
Enumeration Date:2023-06-26
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician