BRAZOSPORT PROFESSIONAL EYE CLINIC INC NPI 1073607370

NPI Information

  • NPI: 1073607370
  • Provider Name: BRAZOSPORT PROFESSIONAL EYE CLINIC INC
  • Classification: Optometrist - 152W00000X
  • Entity Type: Organization
  • Doing Business As: MARK A PROVENZANO OD
  • Address: 123 CIRCLE WAY
    LAKE JACKSON, TX
    ZIP 77566
  • Phone: (979) 299-3250

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NPI Details

BRAZOSPORT PROFESSIONAL EYE CLINIC INC is an optometrist in Lake Jackson, TX. The provider is 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. An optometrist has completed pre-professional undergraduate education in a college or university and four years of professional education at a college of optometry, leading to the doctor of optometry (O.D.) degree. Some optometrists complete an optional residency in a specific area of practice. Optometrists are eye health care professionals state-licensed to diagnose and treat diseases and disorders of the eye and visual system. BRAZOSPORT PROFESSIONAL EYE CLINIC INC NPI is 1073607370. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Mark A Provenzano Od.

The provider's business location address is:

123 CIRCLE WAY
LAKE JACKSON, TX
ZIP 77566-233
Phone: (979) 299-3250
Fax: (979) 299-1724

The provider's authorized official is Mark Allen Provenzano .
The authorized official title is Owner and has the following contact phone number (979) 299-3250.

The enumeration date for this NPI number is 10/3/2006 and was last updated on 12/11/2008.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1152W00000XOptometrist3979TGTEXASYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
100Z950MEDICARE PINTEXAS
20195042MEDICAIDTEXAS
30328270001MEDICARE NSC
4T92687MEDICARE UPIN
58F9342MEDICARE PINTEXAS
680775QOTHERTEXASBCBS OF TX
700E79KMEDICARE PINTEXAS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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