Optometrist
BRAZOSPORT PROFESSIONAL EYE CLINIC INC
Identity confirmed via CMS NPPES · September 30, 2026 · A directory match is not a coverage approval.
Is this your practice? This listing was imported from public provider identity data (CMS NPPES) and has not yet been claimed. Claim this listing to confirm the practice details. Plan acceptance stays unpublished until the practice reports it.
Public record
NPI 1073607370 · enumerated 2006-10-03 · record updated 2008-12-11. Source: CMS NPPES. A listing is not a TRICARE network approval.
NPPES recordGoogle Maps Apple Maps OpenStreetMap
Authorized official: Dr. MARK PROVENZANO OD, Owner · (979) 299-3250
Other names: MARK A PROVENZANO OD
Addresses and phones
- Mailing address 123 CIRCLE WAY, LAKE JACKSON, TX, 77566-5233 (979) 299-3250 Fax (979) 299-1724 Google Maps Apple Maps OpenStreetMap
- Practice location 123 CIRCLE WAY, LAKE JACKSON, TX, 77566-5233 (979) 299-3250 Fax (979) 299-1724 Google Maps Apple Maps OpenStreetMap
Specialties
- Optometrist 152W00000X · Primary · License 3979TG TX
In this directory
Locations and evidence
-
Practice location
LAKE JACKSON, TX, 775665233
Accepting new patientsNot reportedCMS NPPES · September 30, 2026
Plan acceptance
- No published plan acceptance yet. Confirm directly with the practice, or claim this listing if it's yours.