Timothy R Port Od Inc-Ca

NPI #1962710293 in Blythe, California

Provider Information

NPI Number: 1962710293
Entity Type: Organization
Organization Name: Timothy R Port Od Inc-Ca
Primary Specialty: Optometrist
Enumeration Date: Sep 21, 2010
Last Updated: Aug 23, 2011

Practice Location

Address: 110 N SPRING ST
City: Blythe
State: California
ZIP Code: 92225-1633
Phone: (760) 922-3951

Authorized Official

Name: DR. TIMOTHY REEVE PORT, O.D.
Title: PRESIDENT
Phone: (760) 922-3951

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Optometrist	152W00000X	Primary

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