Fagan, Lance William
Fagan, Lance William is an individual health care provider with primary practice located at 1801 N 3Rd St , Coeur D Alene ID 83814-3400. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Fagan, Lance William can be contacted via phone (208) 667-1591.Contact Information
Primary practice address
1801 N 3Rd St
Coeur D Alene ID 83814-3400
Phone: (208) 667-1591
Fax: (208) 676-8574
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Eye and Vision Services Providers / Optometrist | 152W00000X | IDP1029 | Idaho |
Profile Details
| NPI number | 1891775151 |
|---|---|
| LBN Legal business name | Fagan, Lance William |
| Credentials | Doctor of Optometry (OD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jan 20th, 2006 |
| Last updated | Apr 12th, 2011 - about 14 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1891775151 | NPPES |
| Idaho | MEDICAID | 805917800 |
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