Provider Demographics
NPI:1205415148
Name:DR WILLIAM PORTER PA
Entity Type:Organization
Organization Name:DR WILLIAM PORTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR OF OPTOMETRY
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:RALPH
Authorized Official - Last Name:PORTER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:954-473-2853
Mailing Address - Street 1:12355 NW 15TH ST
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33026-4310
Mailing Address - Country:US
Mailing Address - Phone:954-673-2464
Mailing Address - Fax:
Practice Address - Street 1:805 S UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-3317
Practice Address - Country:US
Practice Address - Phone:954-473-2853
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-07
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty