KOOTENAI VISION, PLLC (NPI# 1386856284) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1386856284 |
| Entity Type | Organization |
| Organization Name | KOOTENAI VISION, PLLC |
| Other Organization Name | KOOTENAI VISION CENTER |
| Practice Address |
1801 N Third St Coeur D Alene ID 83814 |
| Practice Telephone | 2086671591 |
| Practice Fax Number | 2086768574 |
| Mailing Telephone | 2086671591 |
| Mailing Fax Number | 2086768574 |
| Enumeration Date | 2007-05-04 |
| Last Update Date | 2011-04-12 |
| Authorized Official Name | DR. LANCE WILLIAM FAGAN (MANAGING MEMBER) |
| Authorized Official Telephone | 2086672591 |
| Authorized Official Credential | O.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 152W00000X | Optometrist | ODP1029 | ID | Eye and Vision Services Providers |
| Other Name | Type Code |
|---|---|
| Kootenai Vision Center | Doing Business As Name - Organization |
| Street Address |
1801 N THIRD ST |
| City | COEUR D ALENE |
| State | ID |
| Zip Code | 83814 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477162675 | Dehra Mcfaddan | Social Worker | 211 E. Coeur D'alene Ave, 102, Coeur D Alene, ID 83814 | 2020-07-24 |
| 1043838634 | Yendi Labelle | Nurse Practitioner | 1115 N Ironwood Drive, Coeur D'alene, ID 83814 | 2020-07-09 |
| 1295353217 | Cultivation, LLC | Counselor | 211 E. Coeur Dalene Ave. Ste 102, Coeur D'alene, ID 83814 | 2020-07-07 |
| 1306487517 | Northwest Integrated Health, LLP | Clinic/Center | 1250 West N. Northwood Center Ct, Suite B, Coeur D'alene, ID 83814 | 2019-09-30 |
| 1730740465 | Connor Williams | Physical Therapist | 1812 W Lakewood Dr, Ste. 100, Coeur D Alene, ID 83814 | 2019-06-24 |
| 1912480153 | Nadine M Lewis | Social Worker | 211 E. Coeur D'alene Ave., Coeur D'alene, ID 83814 | 2018-09-13 |
| 1992208631 | Orthopedic Surgery and Sports | Orthopaedic Surgery | 1812 N Lakewood Drive, Suite 100, Coeur D'alene, ID 83814 | 2018-03-08 |
| 1346758042 | Heather Marie Johnson | Counselor | 7905 Meadowlark Way, Cda, ID 83814 | 2018-01-16 |
| 1881113413 | Brevity Treatment Services | Counselor | 2201 N. Government Way Ste. L, Coeur D'alene, ID 83814 | 2017-09-14 |
| 1366969628 | Jennifer La Gina Highfield | Massage Therapist | 1104 N Ste B, Coeur D Alene, ID 83814 | 2017-08-28 |
| Find all providers in zip 83814 | ||||
| Taxonomy Code | 152W00000X |
| Grouping | Eye and Vision Services Providers |
| Classification | Optometrist |
| Doctors of optometry (ODs) are the primary health care professionals for the eye. Optometrists examine, diagnose, treat, and manage diseases, injuries, and disorders of the visual system, the eye, and associated structures as well as identify related systemic conditions affecting the eye. An optometrist has completed pre-professional undergraduate education in a college or university and four years of professional education at a college of optometry, leading to the doctor of optometry (O.D.) degree. Some optometrists complete an optional residency in a specific area of practice. Optometrists are eye health care professionals state-licensed to diagnose and treat diseases and disorders of the eye and visual system. |
| Notes: Source: American Optometric Association (AOA), approved by the AOA’s Board of Trustees, June 21, 2005. [7/1/2006: definition modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558659375 | Lindsay Jean Hamlin | Optometrist | 3879 N Schreiber Way, Coeur D Alene, ID 83815-8362 | 2011-07-13 |
| 1184854408 | Lisa L Robinson Od PC | Optometrist | 409 W Neider Ave Ste C, Coeur D Alene, ID 83815-9423 | 2009-07-21 |
| 1598881351 | Coeur Dalene Vision Source | Optometrist | 850 W Ironwood Dr Ste 104, Coeur D Alene, ID 83814-4903 | 2007-03-22 |
| 1417082660 | Lisa L Robinson | Optometrist | 409 W Neider Ave, Ste C, Coeur D Alene, ID 83815-9423 | 2007-02-21 |
| 1104934686 | Roy Lavern Clapper | Optometrist | 355 E Neider Ave, Coeur D Alene, ID 83815-3723 | 2006-08-26 |
| 1285624601 | John L Calderwood | Optometrist | 312 N 4th St, Coeur D Alene, ID 83814-2812 | 2005-10-26 |
| 1710972450 | Wayne D Ellenbecker | Optometrist | 1250 W Ironwood Dr, Suite 201, Coeur D Alene, ID 83814-2679 | 2005-09-19 |
| 1427688431 | Key Vision Services, P.C. | Optometrist | 355 E Neider Ave, Coeur D Alene, ID 83815-3723 | 2020-01-17 |
| 1598319337 | Haley Vision Center, Pllc | Optometrist | 217 W Ironwood Dr, Coeur D Alene, ID 83814-2651 | 2019-07-30 |
| 1225489347 | Michael Adam Park | Optometrist | 1801 N 3rd St, Coeur D Alene, ID 83814-3400 | 2016-06-30 |
| Find all providers in COEUR D ALENE | ||||
| City | COEUR D ALENE |
| Zip Code | 83814 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.