Provider Demographics
NPI:1821082470
Name:OUGH, LANCE F (OD)
Entity Type:Individual
Prefix:
First Name:LANCE
Middle Name:F
Last Name:OUGH
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 QUAIL LN
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83716-3114
Mailing Address - Country:US
Mailing Address - Phone:208-343-0046
Mailing Address - Fax:
Practice Address - Street 1:350 N MILWAUKEE ST
Practice Address - Street 2:#2153
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-9123
Practice Address - Country:US
Practice Address - Phone:208-322-1642
Practice Address - Fax:208-378-4179
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDODP 100038152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management