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NPI Code Detail

MEDICARE: MARVIN I PORTON O.D., INC.

MEDICARE: MARVIN I PORTON O.D., INC.
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
1152W00000XOptometrist117CA

General Provider Information

NPI Number : 1376654061
Entity Type Code : Organization
Provider Name (Legal Business Name) : MARVIN I PORTON O.D., INC.
Provider Business Mailing Address
First Line : 804 S VICTORY BLVD
Second Line : SUITE A
City : BURBANK
State : CA
Zip : 91502-2427
Country : US
Telephone Number : 808-843-3544
Fax Number : 808-845-0065
Provider Business Practice Location Address
First Line : 804 S VICTORY BLVD
Second Line : SUITE A
City : BURBANK
State : CA
Zip : 91502-2427
Country : US
Telephone Number : 818-843-3544
Fax Number : 818-845-0065
Authorized Official
Title or Position : OWNER
Name : DR. MARVIN ISAAC PORTON
Credential : O.D.
Telephone Number : 626-806-5071
Provider Enumeration Date : 08/31/2006
Last Update Date : 12/21/2009

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Directions to “MARVIN I PORTON O.D., INC. ” Practice Location

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