Organization
BRAZOSPORT PROFESSIONAL EYE CLINIC INC
Active
Other names
Mark A Provenzano OD
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK ALLEN PROVENZANO OD (OWNER)
(979) 299-3250
Entity
Organization
Contact information
Practice address
123 CIRCLE WAY, LAKE JACKSON, TX 77566-5233
(979) 299-3250
(979) 299-1724
Mailing address
123 CIRCLE WAY, LAKE JACKSON, TX 77566-5233
(979) 299-3250
(979) 299-1724
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
3979TG
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0195042
—
TX
01
—
80775Q
BCBS OF TX
TX
Enumeration date
10/03/2006
Last updated
12/11/2008
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us