Doctor Name: | ALPHONSO D PORTER |
NPI Number: | 1215109996 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LDO |
License Number: | 488 |
Business Practice Address: | 3118-a Washington Rd East Point, GA - 30346 |
Business Phone Number: | 4047673995 |
Business Fax Number: | 4047673987 |
Mailing Address: | 3118-a Washington Rd, EAST POINT |
State: | GA |
Postal Code: | 30346 |
Phone Number: | 4047673995 |
Fax Number: | 4047673987 |
NPI Enumeration Date: | 04/02/2008 |
NPI Last Update Date: | 04/02/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 156FX1800X |
License Number: | 488 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | GA |
Taxonomy Type: | Eye and Vision Services Providers |
Taxonomy Classification: | Technician/Technologist |
Taxonomy Specialization: | Optician |
Taxonomy Definition: |