BRAZOSPORT PROFESSIONAL EYE CLINIC INC


Address: 123 Circle Way, Lake Jackson, TX 77566-5233
Phone: 9792993250

BRAZOSPORT PROFESSIONAL EYE CLINIC INC (NPI# 1073607370) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1073607370
Entity Type Organization
Organization Name BRAZOSPORT PROFESSIONAL EYE CLINIC INC
Other Organization Name MARK A PROVENZANO OD
Practice Address 123 Circle Way
Lake Jackson
TX 77566-5233
Practice Telephone 9792993250
Practice Fax Number 9792991724
Mailing Telephone 9792993250
Mailing Fax Number 9792991724
Enumeration Date 2006-10-03
Last Update Date 2008-12-11
Authorized Official Name DR. MARK ALLEN PROVENZANO (OWNER)
Authorized Official Telephone 9792993250
Authorized Official Credential OD
Is Organization Subpart N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 152W00000X Optometrist 3979TG TX Eye and Vision Services Providers

Other Provider Identifier

State Issuer Identifier Type Code
TX 0195042 05
TX BCBS OF TX 80775Q 01

Other Provider/Organization Names

Other Name Type Code
Mark A Provenzano OD Doing Business As Name - Organization

Office Location

Street Address 123 CIRCLE WAY
City LAKE JACKSON
State TX
Zip Code 77566-5233

Providers in the same location

NPI Name Taxonomy Address Enumeration
1942486428 Mark A Provenzano Optometrist 123 Circle Way, Lake Jackson, TX 77566-5233 2008-01-15

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1588271746 Daniel Kent Pharmacist 121 Tx-332 W, Lake Jackson, TX 77566 2020-09-30
1134692403 Gulf Coast Gastroenterology Lab Clinical Medical Laboratory 219 Oak Drive South, Suite A, Lake Jackson, TX 77566 2019-01-09
1194266288 Kaitlin Dingee Nurse Practitioner 208 Oak Dr S Ste 502, Lake Jackson, TX 77566 2017-03-09
1326581935 Nec Lake Jackson Emergency Center, Lp Clinic/Center 103 Winding Way, Lake Jackson, TX 77566 2016-11-30
1548618911 Sara Eddy Counselor 109 Circle Way, Lake Jackson, TX 77566 2016-05-26
1689020158 Baker Chiropractic Center Pllc Chiropractor 100-a Plantation Drive, Lake Jackson, TX 77566 2016-05-13
1326409368 Janet Chen Pharmacist 131 Oyster Creek Dr., Lake Jackson, TX 77566 2016-03-18
1164819488 Eco Dental Care, Pllc Dentist 210 Lake Rd, Ste 800 A, Lake Jackson, TX 77566 2015-04-24
1730578196 Anna Katherine Tucker Occupational Therapy Assistant 1052 Cardinal Dr, Richwood, TX 77566 2015-01-22
1306243035 H-e-b, Lp Clinical Medical Laboratory 97 Oyster Creek Drive, Lake Jackson, TX 77566 2014-11-24
Find all providers in zip 77566

Taxonomy Information

Taxonomy Code 152W00000X
Grouping Eye and Vision Services Providers
Classification Optometrist

Taxonomy Definition

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.
Notes: Source: American Optometric Association (AOA), approved by the AOA’s Board of Trustees, June 21, 2005. [7/1/2006: definition modified]

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1770129827 Brazos Eye Care LLC Optometrist 100 Highway 332 W Ste 1242, Lake Jackson, TX 77566-4037 2019-11-25
1578043097 Cody James Armstrong Optometrist 126 Oyster Creek Dr, Lake Jackson, TX 77566-4463 2018-08-14
1467938878 Darrin C. Shandley Optometrist 120 Highway 332 W Ste A5, Lake Jackson, TX 77566-4017 2018-07-18
1518443175 Monroe Eye Site Inc Optometrist 100 Highway 332 W Ste 1410, Lake Jackson, TX 77566-4016 2018-07-17
1124472717 The Eye Contact, Inc. Optometrist 4 W Way Ct, Lake Jackson, TX 77566-5242 2016-04-20
1366798415 Kelley D Kweon Optometrist 121 Highway 332 W Ste 100, Lake Jackson, TX 77566 2012-07-26
1326109661 William Jackson Jr. Optometrist 4 West Way Court, Lake Jackson, TX 77566-5242 2006-12-12
1710076021 Robert G Haws Optometrist 126 Oyster Creek Dr Ste A, Lake Jackson, TX 77566-4463 2006-10-12
1417900036 Brian K Shandley Optometrist 120 Hwy 332 W, Ste A5, Lake Jackson, TX 77566-4017 2006-05-17
1649506981 Kayla H Dao Optometrist 121 Highway 332 W, Suite 100, Lake Jackson, TX 77566-4028 2009-10-21
Find all providers in LAKE JACKSON

Competitor

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City LAKE JACKSON
Zip Code 77566

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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