Provider Demographics
NPI:1356952808
Name:SPAGNOLA, LACIE CATHERINE (OD)
Entity type:Individual
Prefix:DR
First Name:LACIE
Middle Name:CATHERINE
Last Name:SPAGNOLA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:MS
Other - First Name:LACIE
Other - Middle Name:CATHERINE
Other - Last Name:WATSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS
Mailing Address - Street 1:1257 SW 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:OR
Mailing Address - Zip Code:97914-4516
Mailing Address - Country:US
Mailing Address - Phone:541-889-2191
Mailing Address - Fax:541-881-1523
Practice Address - Street 1:1257 SW 4TH AVE
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:OR
Practice Address - Zip Code:97914-4516
Practice Address - Country:US
Practice Address - Phone:541-889-2191
Practice Address - Fax:541-881-1523
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-10
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4539152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist