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Mark Provenzano, O.D
NPI 1942486428 · on the registry since 2008 · sole proprietor
Practice
- Address
- 123 Circle Way
Lake Jackson, TX 77566 - Phone
- (979) 299-3250
- Organisation at this address
- Brazosport Professional Eye Clinic Inc
Inferred from a shared address, not stated in the registry.
Registry record
- Primary taxonomy
- Optometrist
152W00000X
- Licence states on file
- TX
From the registry's licence fields, which are often incomplete.
- Sex
- Male
- Record last updated
- 2009-04-21
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Texas