NPI 1285963769

Richard a Portillo O D a Professional Optometric Corporation

Organisation Point of Service Modesto, CA

Practice location

Address: 1624 I St, Modesto, CA 95354-1122
Phone: (209) 578-4885
Mailing address: PO Box 1743, Modesto, CA 95353-1743

Authorised official

Name: Richard Alan Portillo
Title: President
Phone: (209) 578-4885

Registered specialties

Point of Service Primary

Managed Care Organizations Taxonomy 305S00000X Licence 7865T (CA)

Other Point of Service providers in California →

Registry record

NPI: 1285963769
Entity type: Organization
NPI issued: 13 Dec 2009
Record last updated: 18 Sep 2012

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.