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General NPI Number Information
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NPI Number | 1548440019
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Entity Type | Organization
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Legal Business Name | LAGRECA EYE CLINIC PC
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Dates
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Enumeration Date | 11/13/2007
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Last Update Date | 12/29/2011
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Provider Practice Location Address
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Address Line | 1150 MAIN ST
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City | LANDER
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State | WY
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Zip | 82520-2620
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Country | US
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Telephone | 307-332-5272
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Fax | 307-332-9481
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Provider Business Mailing Address
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Address Line | 2475 VILLAGE LN #202
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City | BILLINGS
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State | MT
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Zip | 59102-2497
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Country | US
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Telephone | 406-252-6608
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Fax | 406-252-6600
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Authorized Official
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Title or Position | BILLING SUPERVISOR
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Name | MRS. LOLA J. PROCTOR
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Credential |
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Telephone | 406-294-6586
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number |
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License Number State | WY
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