# LAGRECA EYE CLINIC, P.C.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** The Eye Clinic Surgicenter
- **Organization subpart:** No

## Provider details

- **NPI number:** 1427183664
- **Authorized official:** DR. BRIAN A LAGRECA M.D. (MD PRESIDENT)
- **Authorized official phone:** (406) 252-6608

## Contact information

- **Practice address:** 1150 MAIN ST, LANDER, WY 82520-2620
- **Practice address phone:** (307) 332-5272
- **Practice address fax:** (307) 332-5272
- **Mailing address:** 1150 MAIN ST, LANDER, WY 82520-2620
- **Mailing address phone:** (307) 338-5272
- **Mailing address fax:** (307) 338-5272

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | 10106 | WY | Yes |

## Other

- **Enumeration date:** 02/21/2007
- **Last updated:** 12/29/2011

## 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 |