Brazosport Professional Eye Clinic INC

NPI #1073607370 in Lake Jackson, Texas

Provider Information

NPI Number: 1073607370
Entity Type: Organization
Organization Name: Brazosport Professional Eye Clinic INC
Primary Specialty: Optometrist
Enumeration Date: Oct 3, 2006
Last Updated: Dec 11, 2008

Practice Location

Address: 123 CIRCLE WAY
City: Lake Jackson
State: Texas
ZIP Code: 77566-5233
Phone: (979) 299-3250

Authorized Official

Name: DR. MARK ALLEN PROVENZANO, OD
Title: OWNER
Phone: (979) 299-3250

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Optometrist	152W00000X	Primary

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