St Maries Vision Center, Pllc

NPI #1780190694 in St Maries, Idaho

Provider Information

NPI Number: 1780190694
Entity Type: Organization
Organization Name: St Maries Vision Center, Pllc
Primary Specialty: Optometrist
Enumeration Date: Dec 15, 2017
Last Updated: Dec 15, 2017

Practice Location

Address: 704 W COLLEGE AVE
City: St Maries
State: Idaho
ZIP Code: 83861-1824
Phone: (208) 245-6563

Authorized Official

Name: DR. LANCE WILLIAM FAGAN, OD
Title: OWNER
Phone: (208) 245-6563

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Optometrist	152W00000X	Primary

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