Provider Demographics
NPI:1770945818
Name:VENITTELLI KOWALSKI OPTOMETRIC CORP
Entity type:Organization
Organization Name:VENITTELLI KOWALSKI OPTOMETRIC CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:MS
Authorized Official - First Name:IRENE
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-600-9226
Mailing Address - Street 1:39252 WINCHESTER RD STE 127
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92563-3511
Mailing Address - Country:US
Mailing Address - Phone:951-600-9226
Mailing Address - Fax:866-268-5816
Practice Address - Street 1:39252 WINCHESTER RD STE 127
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92563-3511
Practice Address - Country:US
Practice Address - Phone:951-600-9226
Practice Address - Fax:866-268-5816
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-28
Last Update Date:2016-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty