Marc A Provencher, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

2025 Issued in CO

Practice address

4050 S Timberline Rd Unit 120
Fort Collins, CO 80525-6023

Phone

(970) 282-8888

Fax

(970) 282-8484

NPI assigned

Nov 9, 2006

Last updated

Nov 2, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Eyecare for You LLC

  • Optometrist
  • Fort Collins, CO
  • NPI 1508198433
  Authorized official Same address or phone
• Marc a Provencher

  dba Eyecare for You

  • Optometrist
  • Fort Collins, CO
  • NPI 1275717266
  Authorized official Same address or phone
• Eklund Optometric Group

  dba Wellington Eye Care

  • Corneal and Contact Management Optometrist
  • Wellington, CO
  • NPI 1871789065
  NPD (past)
• Tanner Vision PC

  dba Premier Family Eyecare

  • Optometrist
  • Loveland, CO
  • NPI 1144526401
  NPD (past)
• Tanner Vision PC

  dba Premier Family Eyecare

  • Optometrist
  • Loveland, CO
  • NPI 1659005387
  NPD (past)
• Eklund Optometric Group, LLC

  • Optometrist
  • Cheyenne, WY
  • NPI 1710040241
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1163030400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1667347200000",
    "number": "1184794745",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4050 S TIMBERLINE RD UNIT 120",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805256023",
            "telephone_number": "970-282-8888",
            "fax_number": "970-282-8484"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4050 S TIMBERLINE RD UNIT 120",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805256023",
            "telephone_number": "970-282-8888",
            "fax_number": "970-282-8484"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "114 14th St SW",
            "address_purpose": "LOCATION",
            "city": "Loveland",
            "state": "CO",
            "postal_code": "805376341",
            "country_code": "US",
            "telephone_number": "970-587-3937",
            "fax_number": "970-622-0648",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PROVENCHER",
        "first_name": "MARC",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-09",
        "last_updated": "2022-11-02",
        "certification_date": "2022-11-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CO",
            "license": "2025",
            "primary": true
        },
        {
            "code": "152WC0802X",
            "taxonomy_group": "",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": "WY",
            "license": "209T",
            "primary": false
        },
        {
            "code": "152WC0802X",
            "taxonomy_group": "",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": "CO",
            "license": "2025",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TYPE 2 NPI",
            "identifier": "1659005387",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Promdix LLC
• Prosthetic & Orthotic Group of Northern Co., LLC
• Alyssa Proulx Bostrom
• Evan Proulx Bostrom
• David Andrew Prouty, MSW
• Provision Imaging of Ft Collins
• Prows Family Medicine PLLC
• Joseph W Prows, MD
• Joel Przybyla, PT, DPT
• Psychhorizons, P.C.

• Optometrist in Fort Collins, CO
• Providers in Fort Collins, CO by specialty
• Optometrist in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.