Organization
RICHARD A PORTILLO O D A PROFESSIONAL OPTOMETRIC CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RICHARD ALAN PORTILLO O.D. (PRESIDENT)
(209) 578-4885
Entity
Organization
Contact information
Practice address
1624 I ST, MODESTO, CA 95354-1122
(209) 578-4885
Mailing address
PO BOX 1743, MODESTO, CA 95353-1743
(209) 578-4885
Taxonomy
Speciality
Code
Description
License number
State
305S00000X
Point of Service
Primary
7865T
CA
Other
Enumeration date
12/13/2009
Last updated
09/18/2012
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