Provider Demographics
NPI:1972814374
Name:VILLAVICENCIO, OVETTE (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:OVETTE
Middle Name:
Last Name:VILLAVICENCIO
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3925 E FORT LOWELL RD STE 100
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-1053
Mailing Address - Country:US
Mailing Address - Phone:520-576-5110
Mailing Address - Fax:520-529-7165
Practice Address - Street 1:3925 E FORT LOWELL RD STE 100
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-1053
Practice Address - Country:US
Practice Address - Phone:520-576-5110
Practice Address - Fax:520-529-7165
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-30
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01073604A207W00000X
AZR72235390200000X
AZ50246207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program