Kootenai Vision, Pllc
NPI #1386856284 in Coeur D Alene, Idaho
Provider Information
- NPI Number
- 1386856284
- Entity Type
- Organization
- Organization Name
- Kootenai Vision, Pllc
- Primary Specialty
- Optometrist
- Enumeration Date
- May 4, 2007
- Last Updated
- Apr 12, 2011
Practice Location
- Address
- 1801 N THIRD ST
- City
- Coeur D Alene
- State
- Idaho
- ZIP Code
- 83814
- Phone
- (208) 667-1591
Authorized Official
- Name
- DR. LANCE WILLIAM FAGAN, O.D.
- Title
- MANAGING MEMBER
- Phone
- (208) 667-2591
Specialties & Taxonomy Codes
| Specialty |
|---|
| Optometrist |
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