Individual
ROGER R GAGNON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
510 MAINEMALL RD., SOUTH PORTLAND, ME 04106
(207) 775-2030
(207) 775-0755
Mailing address
510 MAINEMALL ROAD, SOUTH PORTLAND, ME 04106
(207) 775-2030
(207) 775-0755
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OPT740
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
121300099
—
ME
Enumeration date
09/22/2006
Last updated
01/26/2010
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