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Individual
DR. MARK AUGUSTO VENTOCILLA
Active
Individual
DR. MARK AUGUSTO VENTOCILLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
10435
CA
152W00000X
Optometrist
4901003734
MI
152W00000X
Optometrist
OPC 3532
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4454950
—
MI
05
—
4820570
—
MI
01
—
900F165350
BCBS LAKESHORE EYECARE
MI
01
—
90G011590
BCBS ELDER EYECARE GROUP
MI
Enumeration date
10/12/2006
Last updated
03/12/2012
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