| Doctor Name: | LACEY BOGGAN |
| NPI Number: | 1053709865 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | |
| Business Practice Address: | 9 N Main St Deer Park, WA - 99006 |
| Business Phone Number: | 5092760026 |
| Business Fax Number: | |
| Mailing Address: | 41007 N Running Deer Ln, DEER PARK |
| State: | WA |
| Postal Code: | 990065128 |
| Phone Number: | 5092760026 |
| Fax Number: | |
| NPI Enumeration Date: | 12/31/2014 |
| NPI Last Update Date: | 12/31/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 332H00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WA |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Eyewear Supplier (Equipment, not the service) |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An organization that provides spectacles, contact lenses, and other vision enhancement devices prescribed by an optometrist or ophthalmologist. |