| Mark A Provenzano Od | |
|
123 Circle Way, Lake Jackson, TX 77566-5233 | |
| (979) 299-3250 | |
| (979) 299-1724 |
| Full Name | Mark A Provenzano Od |
|---|---|
| Type | Facility |
| Speciality | Optometrist |
| Location | 123 Circle Way, Lake Jackson, Texas |
| Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073607370 | NPI | - | NPPES |
| 0195042 | Medicaid | TX | |
| 80775Q | Other | TX | BCBS OF TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 152W00000X | Optometrist | 3979TG (Texas) | Primary |
| Provider Name | Mark A Provenzano |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1942486428 PECOS PAC ID: 8224198916 Enrollment ID: I20081126000099 |
| Mailing Address | Practice Location Address |
|---|---|
| Mark A Provenzano Od 123 Circle Way, Lake Jackson, TX 77566-5233 Ph: (979) 299-3250 | Mark A Provenzano Od 123 Circle Way, Lake Jackson, TX 77566-5233 Ph: (979) 299-3250 |
Dr. Julie Nguyen Optometrist Medicare: Not Enrolled in Medicare Practice Location: 121 Highway 332 W, Suite 100, Lake Jackson, TX 77566 Phone: 979-480-9424 Fax: 979-480-9426 |
America's Best Contacts & Eyeglasses Optometrist Medicare: Not Enrolled in Medicare Practice Location: 121 Highway 332 W Ste D, Lake Jackson, TX 77566 Phone: 979-258-7716 |
The Eye Contact, Inc. Optometrist Medicare: Not Enrolled in Medicare Practice Location: 4 W Way Ct, Lake Jackson, TX 77566 Phone: 979-297-3937 Fax: 979-297-9889 |
Dr. Julie Thuydung Nguyen, OD Optometrist Medicare: Accepting Medicare Assignments Practice Location: 121 Highway 332 W, 100, Lake Jackson, TX 77566 Phone: 979-480-9424 Fax: 979-480-9426 |
Robert G. Haws, O.d. P.a. Optometrist Medicare: Medicare Enrolled Practice Location: 126 Oyster Creek Dr Ste A, Lake Jackson, TX 77566 Phone: 979-299-0100 Fax: 979-299-6181 |
Donovan Pham, Optometrist Medicare: Not Enrolled in Medicare Practice Location: 121 Highway 332 W Ste D, Lake Jackson, TX 77566 Phone: 979-258-7716 |
Dr. William Jackson Jr., O.D. Optometrist Medicare: Accepting Medicare Assignments Practice Location: 4 West Way Court, Lake Jackson, TX 77566 Phone: 979-297-3937 Fax: 979-297-9889 |