Provider Demographics
NPI:1083748925
Name:MICHAEL J. PORTZ, O.D., P.C.
Entity Type:Organization
Organization Name:MICHAEL J. PORTZ, O.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:PORTZ
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:712-623-5551
Mailing Address - Street 1:PO BOX 463
Mailing Address - Street 2:
Mailing Address - City:RED OAK
Mailing Address - State:IA
Mailing Address - Zip Code:51566-0463
Mailing Address - Country:US
Mailing Address - Phone:712-623-5551
Mailing Address - Fax:712-623-4745
Practice Address - Street 1:1409 N 2ND ST
Practice Address - Street 2:
Practice Address - City:RED OAK
Practice Address - State:IA
Practice Address - Zip Code:51566-1043
Practice Address - Country:US
Practice Address - Phone:712-623-5551
Practice Address - Fax:712-623-4745
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0149320001Medicare NSC