Healthcare Provider Details

I. General information

NPI: 1689669749
Provider Name (Legal Business Name): BARBARA R. PORTER O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2005
Last Update Date: 07/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 N CHESTNUT ST
SCOTTDALE PA
15683-1714
US

IV. Provider business mailing address

656 S GEARY ST
MOUNT PLEASANT PA
15666-1220
US

V. Phone/Fax

Practice location:
  • Phone: 724-887-5820
  • Fax: 724-887-5825
Mailing address:
  • Phone: 724-542-8009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG000416
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: