Individual
MICHAEL J PORTZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
1409 N 2ND ST, RED OAK, IA 51566-1043
(712) 623-5551
(712) 623-4745
Mailing address
1409 N 2ND ST, PO BOX 463, RED OAK, IA 51566-1043
(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
—
0078618
—
IA
01
—
27984
WELLMARK BCBS
IA
Enumeration date
08/09/2005
Last updated
06/13/2008
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