Organization
ST MARIES VISION CENTER, PLLC
Active
Other names
St Maries Vision Center
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LANCE WILLIAM FAGAN OD (OWNER)
(208) 245-6563
Entity
Organization
Contact information
Practice address
704 W COLLEGE AVE, ST MARIES, ID 83861-1824
(208) 245-6563
Mailing address
704 W COLLEGE AVE, ST MARIES, ID 83861-1824
(208) 245-6563
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
ODP1029
ID
Other
Enumeration date
12/15/2017
Last updated
12/15/2017
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