Provider Demographics
NPI:1194715318
Name:GAGNON, ARMAND L JR (OD)
Entity type:Individual
Prefix:DR
First Name:ARMAND
Middle Name:L
Last Name:GAGNON
Suffix:JR
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:1919 28TH AVE S
Mailing Address - Street 2:STE 117
Mailing Address - City:HOMEWOOD
Mailing Address - State:AL
Mailing Address - Zip Code:35209-2684
Mailing Address - Country:US
Mailing Address - Phone:205-879-6300
Mailing Address - Fax:205-879-6302
Practice Address - Street 1:1919 28TH AVE S
Practice Address - Street 2:STE 117
Practice Address - City:HOMEWOOD
Practice Address - State:AL
Practice Address - Zip Code:35209-2684
Practice Address - Country:US
Practice Address - Phone:205-879-6300
Practice Address - Fax:205-879-6302
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-27
Last Update Date:2014-06-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AL566152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALT-91654Medicare UPIN
1770735417Medicare PIN
AL000058285Medicare PIN
AL510G700412Medicare PIN
ALCH7734Medicare PIN