Healthcare Provider Details

I. General information

NPI: 1619935103
Provider Name (Legal Business Name): VENTURA OPTOMETRIC VISION CARE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 04/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1280 S VICTORIA AVE SUITE 100
VENTURA CA
93003-6555
US

IV. Provider business mailing address

1280 S VICTORIA AVE SUITE 100
VENTURA CA
93003-6555
US

V. Phone/Fax

Practice location:
  • Phone: 805-650-9922
  • Fax: 805-650-6656
Mailing address:
  • Phone: 805-650-9922
  • Fax: 805-650-6656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. BRENT K. MITSUUCHI
Title or Position: SECRETARY
Credential: O.D.
Phone: 805-650-9922