Individual
DR. MARC A PROVENCHER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
4050 S TIMBERLINE RD UNIT 120, FORT COLLINS, CO 80525-6023
(970) 282-8888
(970) 282-8484
Mailing address
4050 S TIMBERLINE RD UNIT 120, FORT COLLINS, CO 80525-6023
(970) 282-8888
(970) 282-8484
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2025
CO
152WC0802X
Corneal and Contact Management Optometrist
2025
CO
152WC0802X
Corneal and Contact Management Optometrist
209T
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1659005387
TYPE 2 NPI
—
Enumeration date
11/09/2006
Last updated
11/02/2022
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