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Organization
TIMOTHY R PORT OD INC-CA
Active
Organization
TIMOTHY R PORT OD INC-CA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TIMOTHY REEVE PORT O.D. (PRESIDENT)
(760) 922-3951
Entity
Organization
Contact information
Practice address
110 N SPRING ST, BLYTHE, CA 92225-1633
(760) 922-3951
(760) 922-5202
Mailing address
110 N SPRING ST, BLYTHE, CA 92225-1633
(760) 922-3951
(760) 922-5202
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
CPT 5925
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11840694
VSP
CA
01
—
16272
MEDICAL EYE SERVIES
CA
01
—
211132
EYE MED
CA
05
—
DN535A
—
CA
01
—
ZZZ50040Z
BLUE CROSS INSURANCE
CA
Enumeration date
09/21/2010
Last updated
08/23/2011
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