Mark Augusto Ventocilla, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

10435 Issued in CA

Practice address

613 E Grand Ave
Escondido, CA 92025-4402

Phone

(760) 747-4797

Fax

(760) 747-7799

NPI assigned

Oct 12, 2006

Last updated

Mar 12, 2012By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: mventocilla3271944@direct.trinity-health.org

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Mark Ventocilla, O.D., Inc

  • Pediatric Optometrist
  • Escondido, CA
  • NPI 1295027613
  Authorized official Same address or phone
• Lakeshore Professional Eyecare PC

  dba Lakeshore Eyecare

  • Optometrist
  • Norton Shores, MI
  • NPI 1629251400
  NPD (past)
• Wyoming Family Vision Care LLC

  dba Wyoming Family Vision Care

  • Optometrist
  • Wyoming, MI
  • NPI 1730583972
  NPD (past)
• Wyoming Family Vision Care PLLC

  • Optometrist
  • Wyoming, MI
  • NPI 1922206531
  NPD (past)

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

{
    "created_epoch": "1160611200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1331510400000",
    "number": "1528158664",
    "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": "760-747-4797",
            "fax_number": "760-747-7799"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VENTOCILLA",
        "first_name": "MARK",
        "middle_name": "AUGUSTO",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-12",
        "last_updated": "2012-03-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MI",
            "license": "4901003734",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "FL",
            "license": "OPC 3532",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "10435",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4454950",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS LAKESHORE EYECARE",
            "identifier": "900F165350",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4820570",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS ELDER EYECARE GROUP",
            "identifier": "90G011590",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jose G Veliz, MD
• Thomas S Velky, M.D.
• Vanessa Venegas
• Veni-Express, Inc.
• Eleni Argyro Venieris-Whitehead, LCSW
• Ri Venuti, PH.D.
• Erika Verduzco
• Luisa Vergara Pereira
• Jinnu Verma, M.D
• Eric Verret, OD

• Optometrist in Escondido, CA
• Providers in Escondido, CA by specialty
• 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.