Mark A Provenzano, O.D. Valid NPI

Individual provider · Optometrist · Lake Jackson, TX

NPI

1942486428

Type

Individual (Type 1)

Primary specialty

Optometrist

Specialty group

Eye and Vision Services Providers

Taxonomy code

152W00000X

License number

3979TG (TX)

Sex

Male

Sole proprietor

Yes

Enumerated

2008-01-15

Last updated

2009-04-21