Healthcare Provider Details

I. General information

NPI: 1194715318
Provider Name (Legal Business Name): ARMAND L GAGNON JR. O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2005
Last Update Date: 06/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 28TH AVE S STE 117
HOMEWOOD AL
35209-2684
US

IV. Provider business mailing address

1919 28TH AVE S STE 117
HOMEWOOD AL
35209-2684
US

V. Phone/Fax

Practice location:
  • Phone: 205-879-6300
  • Fax: 205-879-6302
Mailing address:
  • Phone: 205-879-6300
  • Fax: 205-879-6302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number566
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: