Richard a Portillo O D a Professional Optometric Corporation

Primary specialty

Point of ServiceTaxonomy code 305S00000X

License

7865T Issued in CA

Legal business name

RICHARD A PORTILLO O D A PROFESSIONAL OPTOMETRIC CORPORATION

Practice address

1624 I St
Modesto, CA 95354-1122

Phone

(209) 578-4885

NPI assigned

Dec 13, 2009

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Richard Alan Portillo, O.D.

Title

President

Phone

(209) 578-4885

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1260662400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1347926400000",
    "number": "1285963769",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1743",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953531743",
            "telephone_number": "209-578-4885"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1624 I ST",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953541122",
            "telephone_number": "209-578-4885"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RICHARD A PORTILLO O D A PROFESSIONAL OPTOMETRIC CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-12-13",
        "last_updated": "2012-09-18",
        "status": "A",
        "authorized_official_last_name": "PORTILLO",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "ALAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "209-578-4885",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "305S00000X",
            "taxonomy_group": "",
            "desc": "Point of Service",
            "state": "CA",
            "license": "7865T",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ivy Riblett
• Amber Rice
• Amber Leann Rice
• Daniel Edward Rice, LMFT
• Jamie Lee Rich
• Richard a. Cercle M.D.
• Richard a. Cercle M.D.
• Richard W. Gratian, M.D.
• Jerome Richards, MD
• Michael J Richards, MD

• Point of Service in Modesto, CA
• Providers in Modesto, CA by specialty
• Point of Service in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.