Provencher, Marc A
Provencher, Marc A is an individual health care provider with primary practice located at 4050 S Timberline Rd Unit 120 , Fort Collins CO 80525-6023. He recently has 2 registered licenses in different health care specialties including Eye and Vision Services Providers / Corneal and Contact Management, Eye and Vision Services Providers / Optometrist. Eye and Vision Services Providers / Optometrist is his primary health care specialty. Provencher, Marc A can be contacted via phone (970) 282-8888.Contact Information
Primary practice address
4050 S Timberline Rd Unit 120
Fort Collins CO 80525-6023
Phone: (970) 282-8888
Fax: (970) 282-8484
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Eye and Vision Services Providers / Corneal and Contact Management | 152WC0802X | 209T | Wyoming |
| Eye and Vision Services Providers / Optometrist | 152W00000X | 2025 | Colorado |
| Eye and Vision Services Providers / Corneal and Contact Management | 152WC0802X | 2025 | Colorado |
Profile Details
| NPI number | 1184794745 |
|---|---|
| LBN Legal business name | Provencher, Marc A |
| Credentials | Doctor of Optometry (OD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Nov 9th, 2006 |
| Last updated | Nov 2nd, 2022 - about 4 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1184794745 | NPPES |
| Other | 1659005387 | TYPE 2 NPI |
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