Individual
DR. DODD RANDALL PORTMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
1190 SCOTT BLVD, SANTA CLARA, CA 95050-4562
(408) 241-3510
(408) 247-2605
Mailing address
1190 SCOTT BLVD, SANTA CLARA, CA 95050-4562
(408) 241-3510
(408) 247-2605
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
8010T
CA
152WC0802X
Corneal and Contact Management Optometrist
8010T
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8010T
OPTOMETRY LICENSE #
CA
01
—
BI923Z
MEDICARE PTAN
CA
Enumeration date
01/26/2006
Last updated
03/07/2023
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