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NPI Code Detail

MEDICARE: DR. ADRIA N PORTER OD

MEDICARE: DR. ADRIA N PORTER OD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometrist1619-DTKY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1265429641
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ADRIA N PORTER OD
Provider Business Mailing Address
First Line : PO BOX 37
Second Line :
City : PROVIDENCE
State : KY
Zip : 42450-0037
Country : US
Telephone Number : 270-667-7017
Fax Number : 270-667-9065
Provider Business Practice Location Address
First Line : 215 E MAIN ST
Second Line :
City : PROVIDENCE
State : KY
Zip : 42450-1261
Country : US
Telephone Number : 270-667-7017
Fax Number : 270-667-9065
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/30/2005
Last Update Date : 03/02/2018

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Directions to “ DR. ADRIA N PORTER OD” Practice Location

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