Provider Demographics
NPI:1275717266
Name:MARC A PROVENCHER
Entity Type:Organization
Organization Name:MARC A PROVENCHER
Other - Org Name:EYECARE FOR YOU
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARC
Authorized Official - Middle Name:A
Authorized Official - Last Name:PROVENCHER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:970-282-8888
Mailing Address - Street 1:4050 TIMBERLINE RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-6032
Mailing Address - Country:US
Mailing Address - Phone:970-282-8888
Mailing Address - Fax:970-282-8484
Practice Address - Street 1:4050 TIMBERLINE RD
Practice Address - Street 2:SUITE 120
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-6032
Practice Address - Country:US
Practice Address - Phone:970-282-8888
Practice Address - Fax:970-282-8484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-26
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2025152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty