Provider Demographics
NPI:1356503494
Name:GAGNON, ERIN CHRISTINE (OD)
Entity Type:Individual
Prefix:DR
First Name:ERIN
Middle Name:CHRISTINE
Last Name:GAGNON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:C
Other - Last Name:BARR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:4645 G OSAGE BEACH PARKWAY
Mailing Address - Street 2:
Mailing Address - City:OSAGE BEACH
Mailing Address - State:MO
Mailing Address - Zip Code:65065
Mailing Address - Country:US
Mailing Address - Phone:573-693-9530
Mailing Address - Fax:573-693-9532
Practice Address - Street 1:4645 G OSAGE BEACH PARKWAY
Practice Address - Street 2:
Practice Address - City:OSAGE BEACH
Practice Address - State:MO
Practice Address - Zip Code:65065
Practice Address - Country:US
Practice Address - Phone:573-635-1313
Practice Address - Fax:573-634-8500
Is Sole Proprietor?:No
Enumeration Date:2008-06-30
Last Update Date:2013-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008017086152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist