Organization
ROGER R GAGNON
Active
Other names
Maine Mall Eye Care
Organization subpart
No
Provider details
NPI number
Authorized official
ROGER R GAGNON O.D. (CEO)
(207) 775-2030
Entity
Organization
Contact information
Practice address
510 MAINE MALL, SOUTH PORTLAND, ME 04106-3238
(207) 775-2030
Mailing address
510 MAINE MALL, SOUTH PORTLAND, ME 04106-3238
(207) 775-2030
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
014336
ANTHEM
ME
01
—
1124128913
INDIVIDUAL NPI NUMBER
ME
Enumeration date
08/29/2007
Last updated
12/05/2007
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