Individual
TIMOTHY P ORTIZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O. D.
Contact information
Practice address
880 BEDFORD RD, MORRIS, IL 60450-1209
(815) 942-5500
(815) 942-1851
Mailing address
880 BEDFORD RD, MORRIS, IL 60450-1209
(815) 942-5500
(815) 942-1851
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
046 008365
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0003084001
BLUE CROSS BLUE SHIELD IL
—
05
—
046008365
—
IL
Enumeration date
01/16/2007
Last updated
09/22/2011
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