Individual
LANCE HENDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
134 N STATE ST, PRESTON, ID 83263-1143
(208) 852-3030
Mailing address
749 NORTH 4900 WEST, P.O. BOX 143, DAYTON, ID 83232
(208) 747-3020
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
ODP-1004
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
807028800
—
ID
Enumeration date
01/08/2007
Last updated
04/15/2009
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