Healthcare Provider Details

I. General information

NPI: 1235047515
Provider Name (Legal Business Name): LEWISTON'S VISION SOURCE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1616 19TH AVE
LEWISTON ID
83501-4005
US

IV. Provider business mailing address

17608 128TH PL SE
SNOHOMISH WA
98290-8842
US

V. Phone/Fax

Practice location:
  • Phone: 208-746-3626
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: STANTON SESSIONS
Title or Position: OWNER
Credential: OD
Phone: 360-348-0305