Provider Demographics
NPI:1396737813
Name:ARTIGUE, GARY M (OD)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:M
Last Name:ARTIGUE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1051 GAUSE BLVD
Mailing Address - Street 2:SUITE 480
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458-2951
Mailing Address - Country:US
Mailing Address - Phone:985-649-0206
Mailing Address - Fax:985-649-4060
Practice Address - Street 1:1051 GAUSE BLVD
Practice Address - Street 2:SUITE 480
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-2951
Practice Address - Country:US
Practice Address - Phone:985-649-0206
Practice Address - Fax:985-649-4060
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA987288T152W00000X
MS594152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0880213Medicaid
LA1950734Medicaid
LA1950734Medicaid
47871Medicare ID - Type Unspecified