Active NPI
Timothy R Port OD Inc-Ca
- Optometrist
- Blythe, CA
National Provider Identifier
1962710293
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- CPT 5925
- Legal business name
- TIMOTHY R PORT OD INC-CA
- Practice address
- 110 N Spring St
Blythe, CA 92225-1633 - Phone
- (760) 922-3951
- Fax
- (760) 922-5202
- NPI assigned
- Sep 21, 2010
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Timothy Reeve Port, O.D.
- Title
- President
- Phone
- (760) 922-3951
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | CPT 5925 | CA | Primary |
Addresses
Primary practice location
110 N Spring St
Blythe, CA 92225-1633
Mailing address
110 N Spring St
Blythe, CA 92225-1633
Phone (760) 922-3951
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| ZZZ50040Z | Other | CA | BLUE CROSS INSURANCE |
| DN535A | Medicaid | CA | |
| 16272 | Other | CA | MEDICAL EYE SERVIES |
| 211132 | Other | CA | EYE MED |
| 11840694 | Other | CA | VSP |
National Provider Directory
National Provider DirectoryLocations
836 E Hobsonway
Blythe, CA 92225
Phone (602) 669-2497
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1285027200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1314057600000",
"number": "1962710293",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "110 N SPRING ST",
"city": "BLYTHE",
"state": "CA",
"postal_code": "922251633",
"telephone_number": "760-922-3951",
"fax_number": "760-922-5202"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "110 N SPRING ST",
"city": "BLYTHE",
"state": "CA",
"postal_code": "922251633",
"telephone_number": "760-922-3951",
"fax_number": "760-922-5202"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "TIMOTHY R PORT OD INC-CA",
"organizational_subpart": "NO",
"enumeration_date": "2010-09-21",
"last_updated": "2011-08-23",
"status": "A",
"authorized_official_last_name": "PORT",
"authorized_official_first_name": "TIMOTHY",
"authorized_official_middle_name": "REEVE",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "760-922-3951",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "O.D."
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Optometrist",
"state": "CA",
"license": "CPT 5925",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS INSURANCE",
"identifier": "ZZZ50040Z",
"state": "CA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "DN535A",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICAL EYE SERVIES",
"identifier": "16272",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "EYE MED",
"identifier": "211132",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "VSP",
"identifier": "11840694",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Blythe, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.