Provider Demographics
NPI:1962786038
Name:ORTIZ MELENDEZ, JENNIFER (OD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:
Last Name:ORTIZ MELENDEZ
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:PO BOX 303
Mailing Address - Street 2:
Mailing Address - City:MERCEDITA
Mailing Address - State:PR
Mailing Address - Zip Code:00715-0303
Mailing Address - Country:US
Mailing Address - Phone:787-412-7822
Mailing Address - Fax:787-259-1111
Practice Address - Street 1:8169 CALLE CONCORDIA
Practice Address - Street 2:CONDOMINIO SAN VICENTE SUITE 204
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717
Practice Address - Country:US
Practice Address - Phone:787-259-1111
Practice Address - Fax:787-259-1111
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-06
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR684152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist