RICHARD A PORTILLO O D A PROFESSIONAL OPTOMETRIC CORPORATION (NPI# 1285963769) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1285963769 |
| Entity Type | Organization |
| Organization Name | RICHARD A PORTILLO O D A PROFESSIONAL OPTOMETRIC CORPORATION |
| Practice Address |
1624 I St Modesto CA 95354-1122 |
| Mailing Address |
Po Box 1743 Modesto CA 95353-1743 |
| Practice Telephone | 2095784885 |
| Mailing Telephone | 2095784885 |
| Enumeration Date | 2009-12-13 |
| Last Update Date | 2012-09-18 |
| Authorized Official Name | DR. RICHARD ALAN PORTILLO (PRESIDENT) |
| Authorized Official Telephone | 2095784885 |
| Authorized Official Credential | O.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 305S00000X | Point of Service | 7865T | CA | Managed Care Organizations |
| Street Address |
1624 I ST |
| City | MODESTO |
| State | CA |
| Zip Code | 95354-1122 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255450524 | Richard Alan Portillo | Optometrist | 1624 I St, Modesto, CA 95354-1122 | 2007-03-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669987301 | Tristan Renee Bowman | Student in an Organized Health Care Education/Training Program | 1700 Mchenry Way, Modesto, CA 95354 | 2017-12-04 |
| 1134647944 | Melissa Kathleen Huizar | Occupational Therapist | 730 17th Street, Modesto, CA 95354 | 2017-08-31 |
| 1861948424 | Daniel Jones | Specialist/Technologist | 224 Eula Drive, Modesto, CA 95354 | 2016-09-01 |
| 1710333976 | Elite First Health | Clinic/Center | 3121 Yosemite Blvd Ste D2, Modesto, CA 95354 | 2016-05-06 |
| 1790169084 | Ronika Rodriguez | Licensed Vocational Nurse | 328 Thrasher Ave, Modesto, CA 95354 | 2015-07-16 |
| 1942688528 | Progressive Home Health and Hospice Care, LLC | Home Infusion | 1619 H Street, Modesto, CA 95354 | 2015-05-14 |
| 1225434277 | Ashley Ann Brown | Case Manager/Care Coordinator | 1000 Needham, Modesto, CA 95354 | 2014-11-18 |
| 1922380518 | Thao Truong | Specialist | 1321 I St Ste #3, Modesto, CA 95354 | 2011-09-09 |
| 1437441938 | Amy Marie Lipomi | Counselor | 613 13th Street, Suite B, Modesto, CA 95354 | 2011-05-03 |
| 1871800813 | Patricia Ashley Dalman | Social Worker | 1321 I Street Suite 3, Modesto, CA 95354 | 2010-09-13 |
| Find all providers in zip 95354 | ||||
| Taxonomy Code | 305S00000X |
| Grouping | Managed Care Organizations |
| Classification | Point of Service |
| This product may also be called an open-ended HMO and offers a transition product incorporating features of both HMOs and PPOs. Beneficiaries are enrolled in an HMO but have the option to go outside the networks for an additional cost. |
| Notes: Source: "Glossary of terms used in managed care" Developed by the Managed Care Assembly (MCA) of Medical Group Management Association (MGMA), MGM Journal, September/October 1995, p. 62 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003042383 | Mhn Services | Point of Service | 2260 Floyd Ave, Suite 100, Modesto, CA 95355-9600 | 2009-06-01 |
| 1760736151 | Stanislaus County Behavioral Health | Point of Service | 421 E Morris Ave, Modesto, CA 95354-0437 | 2012-11-06 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.