Richard A Portillo O D A Professional Optometric Corporation
Point of Service in Modesto, CA. Organization (NPI-2).
NPI number1285963769
StatusActive
Last updated in NPPESSep 18, 2012
Details
- NPI
- 1285963769
- Entity type
- Organization (NPI-2)
- Legal business name
- Richard A Portillo O D A Professional Optometric Corporation
- Organization subpart
- No
- Enumeration date
- Dec 13, 2009
- Last updated
- Sep 18, 2012
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 305S00000X | Point of Service | 7865T | CA | Yes |
Practice location
1624 I StModesto, CA 95354-1122
Phone 209-578-4885
Mailing address
Po Box 1743Modesto, CA 95353-1743
Phone 209-578-4885
Authorized official
Richard Alan Portillo
President
2095784885
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