Organization
KOOTENAI VISION, PLLC
Active
Other names
Kootenai Vision Center
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LANCE WILLIAM FAGAN O.D. (MANAGING MEMBER)
(208) 667-2591
Entity
Organization
Contact information
Practice address
1801 N THIRD ST, COEUR D ALENE, ID 83814
(208) 667-1591
(208) 676-8574
Mailing address
1801 N THIRD ST, COEUR D ALENE, ID 83814
(208) 667-1591
(208) 676-8574
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
ODP1029
ID
Other
Enumeration date
05/04/2007
Last updated
04/12/2011
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