| NPI | 1295027613 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK AUGUSTO VENTOCILLA Owner 616-502-0069 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152WP0200X Optometrist, Pediatrics (Licence: CA 10435) |
| Enumeration Date | 2011-05-03 |
| Last Update Date | 2012-03-12 |