Mark Ventocilla, O.D., Inc

Primary specialty

Pediatric OptometristTaxonomy code 152WP0200X

License

10435 Issued in CA

Legal business name

MARK VENTOCILLA, O.D., INC

Practice address

613 E Grand Ave
Escondido, CA 92025-4402

Phone

(760) 747-7979

Fax

(760) 747-7799

NPI assigned

May 3, 2011

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Mark Augusto Ventocilla, OD

Title

Owner

Phone

(616) 502-0069

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1304380800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1331510400000",
    "number": "1295027613",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "613 E GRAND AVE",
            "city": "ESCONDIDO",
            "state": "CA",
            "postal_code": "920254402",
            "telephone_number": "760-747-7979",
            "fax_number": "760-747-7799"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "613 E GRAND AVE",
            "city": "ESCONDIDO",
            "state": "CA",
            "postal_code": "920254402",
            "telephone_number": "760-747-7979",
            "fax_number": "760-747-7799"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARK VENTOCILLA, O.D., INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-05-03",
        "last_updated": "2012-03-12",
        "status": "A",
        "authorized_official_last_name": "VENTOCILLA",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "AUGUSTO",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "616-502-0069",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152WP0200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist, Pediatrics",
            "state": "CA",
            "license": "10435",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Pediatric Optometrist in Escondido, CA
• Providers in Escondido, CA by specialty
• Pediatric Optometrist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.