National Provider Identifier Database

MARK A PROVENZANO, OD – NPI #1942486428
Optometrist

Doctors of optometry (ODs) are the primary health care professionals for the eye. Optometrists examine, diagnose, treat, and manage diseases, injuries, and disorders of the visual system, the eye, and associated structures as well as identify related systemic conditions affecting the eye.


Contact Information

MARK A PROVENZANO, OD
123 CIRCLE WAY
LAKE JACKSON, TX77566-5233
Phone: 979-299-3250
Fax:
Website:
Specialty Taxonomy Code
* Optometrist 152W00000X

* Indicates primary specialty

NPI Profile & details for MARK A PROVENZANO

NPI Number 1942486428
Credentials OD (Doctor of Optometry)
Entity Individual
Enumeration date 01/15/2008
Last updated 04/21/2009 - About 17 years ago
Sole proprietor1 Yes
Identifiers
  • TX License #: 3979TG
  • Other: 80775Q BC/BS TX
  • Other: 1073607370 RAILROAD MEDICARE
Hospital affiliation n/a

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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