| NPI | 1386856284 |
|---|---|
| Doing Business As | KOOTENAI VISION CENTER |
| Entity Type | Organization |
| Authorized Contact | LANCE WILLIAM FAGAN Managing Member 208-667-2591 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: ID ODP1029) |
| Enumeration Date | 2007-05-04 |
| Last Update Date | 2011-04-12 |