NPI 1124128913 · live from the CMS NPI Registry
Roger R Gagnon, O.D.
Optometrist in South Portland, ME. National Provider Identifier 1124128913, active.
NPI record
| NPI | 1124128913 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Optometrist 152W00000X |
| Practice location | 510 Mainemall Rd., South Portland, ME 04106 |
| Practice phone | 207-775-2030 |
| Mailing address | 510 Mainemall Road, South Portland, ME 04106 |
| Enumerated | September 22, 2006 |
| Last updated | January 26, 2010 |
| Sole proprietor | Yes |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Optometrist primary | 152W00000X | OPT740 (ME) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.