Individual
DR. LANCE WILLIAM FAGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
1801 N 3RD ST, COEUR D ALENE, ID 83814-3400
(208) 667-1591
(208) 676-8574
Mailing address
1801 N 3RD ST, COEUR D ALENE, ID 83814-3400
(208) 667-1591
(208) 676-8574
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
IDP1029
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
805917800
—
ID
Enumeration date
01/20/2006
Last updated
04/12/2011
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