Provider Demographics
NPI:1316146301
Name:ORTIZ, KATERIN (OD)
Entity type:Individual
Prefix:DR
First Name:KATERIN
Middle Name:
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2250 MARIETTA BLVD NW
Mailing Address - Street 2:STE 302
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30318
Mailing Address - Country:US
Mailing Address - Phone:404-446-0343
Mailing Address - Fax:404-446-0344
Practice Address - Street 1:2250 MARIETTA BLVD NW
Practice Address - Street 2:STE 302
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30318
Practice Address - Country:US
Practice Address - Phone:404-446-0343
Practice Address - Fax:404-446-0344
Is Sole Proprietor?:No
Enumeration Date:2007-07-11
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA002859152W00000X
NY007262152W00000X
PAOEG001939152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA122699D9AMedicare PIN
PA300027218OtherDAVIS