Individual
DR. CARLOS IVAN ORTIZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
3274 INNER PERIMETER RD, VALDOSTA, GA 31602-1073
(229) 253-9530
Mailing address
4547 TILLMAN BLUFF RD, VALDOSTA, GA 31602-0822
(229) 253-8872
(229) 253-0182
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OPT001470
GA
Other
Enumeration date
09/11/2006
Last updated
07/08/2007
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