Organization
MICHAEL J PORTZ OD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL JOHN PORTZ OD (PRESIDENT)
(712) 623-5551
Entity
Organization
Contact information
Practice address
1409 N SECOND STREET, RED OAK, IA 51566-0463
(712) 623-5551
(712) 623-4745
Mailing address
1409 N SECOND STREET PO BOX 463, RED OAK, IA 51566-0463
(712) 623-5551
(712) 623-4745
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1753
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0445122
—
IA
Enumeration date
08/14/2006
Last updated
08/04/2008
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