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General NPI Number Information
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NPI Number | 1376654061
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Entity Type | Organization
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Legal Business Name | MARVIN I PORTON O.D., INC.
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 12/21/2009
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Provider Practice Location Address
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Address Line | 804 S VICTORY BLVD SUITE A
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City | BURBANK
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State | CA
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Zip | 91502-2427
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Country | US
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Telephone | 818-843-3544
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Fax | 818-845-0065
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Provider Business Mailing Address
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Address Line | 804 S VICTORY BLVD SUITE A
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City | BURBANK
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State | CA
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Zip | 91502-2427
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Country | US
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Telephone | 808-843-3544
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Fax | 808-845-0065
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Authorized Official
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Title or Position | OWNER
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Name | DR. MARVIN ISAAC PORTON
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Credential | O.D.
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Telephone | 626-806-5071
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 117
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License Number State | CA
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