Henderson, Lance

Henderson, Lance is an individual health care provider with primary practice located at 134 N State St , Preston ID 83263-1143. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Henderson, Lance can be contacted via phone (208) 852-3030.

Contact Information

Primary practice address
134 N State St Preston ID 83263-1143
Phone: (208) 852-3030
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Eye and Vision Services Providers / Optometrist 152W00000X ODP-1004 Idaho

Profile Details

NPI number 1225186398
LBN Legal business name Henderson, Lance
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 8th, 2007
Last updated Apr 15th, 2009 - about 17 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1225186398 NPPES
Idaho MEDICAID 807028800

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