Individual
GARY M ARTIGUE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
1051 GAUSE BLVD, SUITE 480, SLIDELL, LA 70458-2951
(985) 649-0206
(985) 649-4060
Mailing address
1051 GAUSE BLVD, SUITE 480, SLIDELL, LA 70458-2951
(985) 649-0206
(985) 649-4060
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
594
MS
152W00000X
Optometrist
Primary
987288T
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0880213
—
MS
05
—
1950734
—
LA
Enumeration date
08/19/2005
Last updated
07/08/2007
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