MARK A PROVENZANO OD
NPI 1073607370
Optometrist in Lake Jackson, TX

Q: What is Brazosport Professional Eye Clinic Inc's specialty?

The primary specialty registered for this NPI is Optometrist with taxonomy code 152W00000X.

Active since October 03, 2006CLIA 45D2049497 · Waiver

123 CIRCLE WAY, LAKE JACKSON, TX 77566(979) 299-3250(979) 299-1724 Get Directions Write a Review

NPPES record last updated: December 11, 2008. Verified against the NPPES registry weekly; last sync: August 30, 2026.

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About Mark A Provenzano Od NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MARK A PROVENZANO OD (NPI 1073607370) is a healthcare organization registered as an optometrist in Lake Jackson, Texas and active in the NPI registry since October 2006. The organization holds a CLIA Waiver certificate valid through November 6, 2026 and lists Mark Allen Provenzano, Owner, as its authorized official.

NPPES Registry Identity

NPI1073607370

Entity TypeOrganization

Primary Taxonomy152W00000X

Legal Business NameBRAZOSPORT PROFESSIONAL EYE CLINIC INC

Location Address123 CIRCLE WAYLake Jackson, TX 77566-5233

Mailing Address123 Circle WayLake Jackson, TX 77566-5233 · (979) 299-3250 · Fax (979) 299-1724

Phone(979) 299-3250

Fax(979) 299-1724

Organization SubpartNo

Authorized OfficialMark Allen ProvenzanoOwner · (979) 299-3250

Enumeration DateOctober 3, 2006

Last NPPES UpdateDecember 11, 2008

✔ NPI 1073607370 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyOptometristEye and Vision Services Providers

Taxonomy Code152W00000X

License✔ Licensed in TX · 3979TG

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.

123 CIRCLE WAY, Lake Jackson, TX 77566

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Other Names 1

Doing Business AsMark A Provenzano Od

Other Identifiers 7

Medicare PIN00Z950TX

Medicaid0195042TX

Medicare NSC0328270001

Medicare UPINT92687

Medicare PIN8F9342TX

Other80775QTX · Bcbs Of Tx

Medicare PIN00E79KTX

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 45D2049497

Brazosport Professional Eye Clinic, Inc · Lake Jackson, TX

Active · expires Nov 6, 2026

CLIA Number45D2049497

Laboratory TypePhysician Office

Certificate Effective DateNovember 7, 2024

Certificate Expiration DateNovember 6, 2026

Laboratory DirectorMark A. Provenzano

Laboratory Phone(979) 299-3250

Laboratory LocationBrazosport Professional Eye Clinic, Inc123 Circle Way, Lake Jackson, TX 77566

CLIA data matches this NPI record on: Address Name Phone

This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. MARK A PROVENZANO O.D.

Optometrist

123 CIRCLE WAY
LAKE JACKSON, TX 77566

Brazoria County (979) 299-3250

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Brazosport Professional Eye Clinic Inc's NPI number?

The NPI number for Brazosport Professional Eye Clinic Inc is 1073607370. It was assigned to this organization in the NPPES registry on October 3, 2006. The provider is doing business as Mark A Provenzano Od.

Where is Brazosport Professional Eye Clinic Inc located?

Brazosport Professional Eye Clinic Inc is located at 123 Circle Way, Lake Jackson, TX 77566. The listed phone number is (979) 299-3250.

What is Brazosport Professional Eye Clinic Inc's specialty?

The primary specialty registered for this NPI is Optometrist with taxonomy code 152W00000X.

Does Brazosport Professional Eye Clinic Inc hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 45D2049497) is associated with this NPI, valid through November 6, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Brazosport Professional Eye Clinic Inc was last updated on December 11, 2008. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 17 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.