Individual
MARY ALICE PORTILLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
2400 SHEILA LN, RICHMOND, VA 23225-2040
(804) 433-1950
Mailing address
136 IVY DR, APT. 12, CHARLOTTESVILLE, VA 22903-5033
(937) 681-2304
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
0618001974
VA
Other
Enumeration date
08/18/2010
Last updated
08/18/2010
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