Organization
JEFFREY S PORTER OD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEFFREY SCOTT PORTER O.D. (PRESIDENT)
(847) 323-8501
Entity
Organization
Contact information
Practice address
1205 S IL ROUTE 31, CRYSTAL LAKE, IL 60014-8213
(915) 477-4053
(815) 477-4302
Mailing address
3912 VALLEY VIEW RD, CRYSTAL LAKE, IL 60012-2104
(815) 479-9246
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
04608991
IL
Other
Enumeration date
12/26/2007
Last updated
08/20/2020
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