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Contact Information

MARC A PROVENCHER, OD
4050 S TIMBERLINE RD UNIT 120
FORT COLLINS, CO80525-6023
 Phone: 970-282-8888
 Fax: 970-282-8484
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Optometrist

152W00000X 41 Optometry
 

Corneal and Contact Management

152WC0802X 41 Optometry
Indicates primary specialty

NPI Profile & details for MARC A PROVENCHER · (Male)

NPI # 1184794745
Status Active
Credentials OD (Doctor of Optometry)
Entity Individual
Enumeration date 11/09/2006
Last updated 11/02/2022 - About 4 years ago
Sole proprietor 1 No
Identifiers
  • CO License # 2025
  • WY License # 209T
  • Other 1659005387 TYPE 2 NPI
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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