Lance William Fagan, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

IDP1029 Issued in ID

Practice address

1801 N 3Rd St
Coeur D Alene, ID 83814-3400

Phone

(208) 667-1591

Fax

(208) 676-8574

NPI assigned

Jan 20, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in ID

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

Pacific University - College of Optometry, 2000

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Kootenai Vision PLLC 3 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Kootenai Vision, PLLC

  • Optometrist
  • Coeur D Alene, ID
  • NPI 1386856284

  ID, Optometrist

  Medicare reassignment Care Compare group NPD Authorized official
• St Maries Vision Center, PLLC

  • Optometrist
  • St Maries, ID
  • NPI 1780190694

  ID, Optometrist

  Medicare reassignment NPD Authorized official
• Panhandle Eye Clinics Chartered

  • Eyewear Supplier
  • St Maries, ID
  • NPI 1275715757
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1137715200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1302566400000",
    "number": "1891775151",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1801 N 3RD ST",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838143400",
            "telephone_number": "208-667-1591",
            "fax_number": "208-676-8574"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1801 N 3RD ST",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838143400",
            "telephone_number": "208-667-1591",
            "fax_number": "208-676-8574"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAGAN",
        "first_name": "LANCE",
        "middle_name": "WILLIAM",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-20",
        "last_updated": "2011-04-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "ID",
            "license": "IDP1029",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "805917800",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• All providers in Coeur D Alene, ID
• Optometrist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.