Provider Demographics
NPI:1619935103
Name:VENTURA OPTOMETRIC VISION CARE INC.
Entity Type:Organization
Organization Name:VENTURA OPTOMETRIC VISION CARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:K
Authorized Official - Last Name:MITSUUCHI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:805-650-9922
Mailing Address - Street 1:1280 S VICTORIA AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-6555
Mailing Address - Country:US
Mailing Address - Phone:805-650-9922
Mailing Address - Fax:805-650-6656
Practice Address - Street 1:1280 S VICTORIA AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-6555
Practice Address - Country:US
Practice Address - Phone:805-650-9922
Practice Address - Fax:805-650-6656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1299830001Medicare NSC
CAWYO87Medicare PIN