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Organization
LAGRECA EYE CLINIC, P.C.
Active
Organization
LAGRECA EYE CLINIC, P.C.
Active
Other names
The Eye Clinic Surgicenter
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRIAN A LAGRECA M.D. (MD PRESIDENT)
(406) 252-6608
Entity
Organization
Contact information
Practice address
1150 MAIN ST, LANDER, WY 82520-2620
(307) 332-5272
(307) 332-5272
Mailing address
1150 MAIN ST, LANDER, WY 82520-2620
(307) 338-5272
(307) 338-5272
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
10106
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
117775303
—
WY
01
—
311774
WY BCBS
WY
01
—
490005573
WY RR MEDICARE
WY
01
—
5205A
WYOMING MEDICAL LICENCE
WY
01
—
7090
MT MEDICAL LICENSE
MT
Enumeration date
02/21/2007
Last updated
12/29/2011
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