# Optical Forums > Canadian Discussion Forum >  Dispensing Fees in Ontario

## Excalibur

do Ontario opticians feel threatened by Ontario optometrists' dispensing fee model?

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## LandLord

Actually, no.  I think it's the other way around.  The good OD's I know tell me they hate the dispensing fee and wish they could go with a markup.  Patients sometimes gets confused and think the dispensing fee makes the doctors office more expensive.  Do you disagree with them?

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## For-Life

I feel it is a colluded, unethical model imposed on the ODs.  It was put in place to destroy the Optician trade, which in Ontario, has made movement on.

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## Excalibur

> I feel it is a colluded, unethical model imposed on the ODs.  It was put in place to destroy the Optician trade, which in Ontario, has made movement on.


What proof do you have that it was "put in place to destroy the optician trade"? 

The dispensing fee model is consistent with other professions that provide a material and good for the patient such as pharmacies and dentists. Are you suggesting that the dispensing fee model be abandoned by pharmacies too, thereby escalating the cost of pharmaceuticals? Ontario Optometrists, as licensed professionals, are merely being consistent with other professional providers that dispense.

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## Excalibur

> Actually, no.  I think it's the other way around.  The good OD's I know tell me they hate the dispensing fee and wish they could go with a markup.  Patients sometimes gets confused and think the dispensing fee makes the doctors office more expensive.  Do you disagree with them?


Patients are shown the math. When we go over the cost of our frame and lenses and add-ons such as A/R and compare them to an average mark-up in a retailer, they are shocked to see how much value we provide them.

I am not allowed to advertise my fees to anyone but my patients. Opticians and retailers can advertise in the media as much their pocketbook will allow. And they most certainly exercise that option!

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## For-Life

> What proof do you have that it was "put in place to destroy the optician trade"? 
> 
> The dispensing fee model is consistent with other professions that provide a material and good for the patient such as pharmacies and dentists. Are you suggesting that the dispensing fee model be abandoned by pharmacies too, thereby escalating the cost of pharmaceuticals? Ontario Optometrists, as licensed professionals, are merely being consistent with other professional providers that dispense.


It is based on the pharmaceutical industry.  Thing is, pharmacists are not competing against another group.

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## LandLord

> Patients are shown the math. When we go over the cost of our frame and lenses and add-ons such as A/R and compare them to an average mark-up in a retailer, they are shocked to see how much value we provide them.
> 
> I am not allowed to advertise my fees to anyone but my patients. Opticians and retailers can advertise in the media as much their pocketbook will allow. And they most certainly exercise that option!


You said that in another thread and it doesn't properly respond to my post.

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## Excalibur

> You said that in another thread and it doesn't properly respond to my post.


No problem. You go to a dispensing fee model and stop advertising 'lowest prices', '2 for 1' and all that sort of stuff and we will all be on an 'even playing field'. 

It looks like we have a profession (optometry) being told by a trade (opticians) that the optometrists are undercutting on pricing. How ironic that a trade is doing less well on pricing than a profession. 

Folks... the dispensing fee model has been around in Ontario for over 30 years. You'd think that by now you would have adjusted your business to it and got over it. Pretty soon optometrists in Ontario will be able to choose whether they wish to charge a dispensing fee or markup. Then, we'll start hearing complaints from opticians that somehow that is unfair too. We can't win!

Stop complaining and being paranoid about optometrists trying to destroy your practices. It's just not happening. Look at your own trade/vocation from within -- educate and regulate yourselves better, stop acting less like vendors and more like health care providers, etc and stop criticizing optometry for your shortfalls.

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## For-Life

> No problem. You go to a dispensing fee model and stop advertising 'lowest prices', '2 for 1' and all that sort of stuff and we will all be on an 'even playing field'. 
> 
> It looks like we have a profession (optometry) being told by a trade (opticians) that the optometrists are undercutting on pricing. How ironic that a trade is doing less well on pricing than a profession. 
> 
> Folks... the dispensing fee model has been around in Ontario for over 30 years. You'd think that by now you would have adjusted your business to it and got over it. Pretty soon optometrists in Ontario will be able to choose whether they wish to charge a dispensing fee or markup. Then, we'll start hearing complaints from opticians that somehow that is unfair too. We can't win!
> 
> Stop complaining and being paranoid about optometrists trying to destroy your practices. It's just not happening. Look at your own trade/vocation from within -- educate and regulate yourselves better, stop acting less like vendors and more like health care providers, etc and stop criticizing optometry for your shortfalls.


It has been around for 30 years, but it has been in practice for just over 10.  Most ODs did not dispense.  

Of course the profession is undercutting the trade.  Like I said, when ODs work with a law that forces them to have prices that Opticians cannot offer then it makes sense.

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## Excalibur

> It has been around for 30 years, but it has been in practice for just over 10.  Most ODs did not dispense.  
> 
> Of course the profession is undercutting the trade.  Like I said, when ODs work with a law that forces them to have prices that Opticians cannot offer then it makes sense.


Nonsense. 

Most ODs dispensed years ago. Opticians feel more threatened by optometric dispensaries because they have modernized their facilities and made the patient buying experience easier and more friendly too.

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## Excalibur

> It has been around for 30 years, but it has been in practice for just over 10.  Most ODs did not dispense.  
> 
> Of course the profession is undercutting the trade.  Like I said, when ODs work with a law that forces them to have prices that Opticians cannot offer then it makes sense.


So... you'll be happier if we RAISE our prices so that you are more competitive? interesting but foolhardy.

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## For-Life

> So... you'll be happier if we RAISE our prices so that you are more competitive? interesting but foolhardy.


No, you ignored what I said to you before.  I would be happier if the restrictions were not in place and you guys were allowed to have competitive pricing.  That means you can continue to do cost plus if you want, but are not forced to.

I think ODs would enjoy it more.  I think it is better for patients, because ODs will see more value in offering better products (only one OD here actually will push better PALS and AR.  The others are too afraid to).

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## For-Life

> Nonsense. 
> 
> Most ODs dispensed years ago. Opticians feel more threatened by optometric dispensaries because they have modernized their facilities and made the patient buying experience easier and more friendly too.


Imperial kept them out of the dispensing market.  Also, we are fair more modernized than any OD in town.  I have no problems with ODs dispensing.  While I think it breaks traditional ethics, I understand that it is evolution.  I have a problem with a colluding pricing scheme.

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## LandLord

Actually, dispensing opticians are only afraid of dispensing optometrists when both compete one to one.  If we have a gun fight and both of us are skilled marksmen -- but the only difference is that you have to get your bullets from me -- then I will win every time.

The sole, dispensing optician is a dying breed.  Today, as in my practice, we have side-by-sides.  My business model is much more powerful than yours because I can undercut you every time and I do.  My store does almost $1M/year, not including the OD exam fees, which he keeps.  There are OD's who would jump at the chance to work "next door" to me because they would make more money.  Maybe some day I'll open a store in Toronto and you can work there.  You'll likely increase your income and cut your headaches in half.

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## Excalibur

> Actually, dispensing opticians are only afraid of dispensing optometrists when both compete one to one.  If we have a gun fight and both of us are skilled marksmen -- but the only difference is that you have to get your bullets from me -- then I will win every time.
> 
> The sole, dispensing optician is a dying breed.  Today, as in my practice, we have side-by-sides.  My business model is much more powerful than yours because I can undercut you every time and I do.  My store does almost $1M/year, not including the OD exam fees, which he keeps.  There are OD's who would jump at the chance to work "next door" to me because they would make more money.  Maybe some day I'll open a store in Toronto and you can work there.  You'll likely increase your income and cut your headaches in half.


Sorry to disappoint you, but my practice grosses over 1M/yr -- no need to offer me 'a job'. Thanks for the generosity.  The money, however, is not necessarily the motivating factor. The motivating factor to stay in private practice is the element of professionalism and being able to provide full-scope, progressive care.. which I do. I have tremendous respect from my large family doctor network as well as my ophthalmology colleagues.  

You state that "my business model is much more powerful than yours because I can undercut you every time and I do". If that's the case, share your wonderful secrets with your optician colleagues who are SO fearful of private optometrists who dispense under a dispensing fee model. Poppycock!

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## Excalibur

> Imperial kept them out of the dispensing market.  Also, we are fair more modernized than any OD in town.  I have no problems with ODs dispensing.  While I think it breaks traditional ethics, I understand that it is evolution.  I have a problem with a colluding pricing scheme.


There is no collusion. Period.

Optometrists can charge any dispensing fee they want. If they wish to charge above the dispensing fee rate, they have to advise the patient of that.

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## Excalibur

> No, you ignored what I said to you before.  I would be happier if the restrictions were not in place and you guys were allowed to have competitive pricing.  That means you can continue to do cost plus if you want, but are not forced to.
> 
> I think ODs would enjoy it more.  I think it is better for patients, because ODs will see more value in offering better products (only one OD here actually will push better PALS and AR.  The others are too afraid to).


Most of our lenses are premium-branded including free-form progressives and the newest coatings.

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## For-Life

> Most of our lenses are premium-branded including free-form progressives and the newest coatings.


That is why I specified not all ODs do it.

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## kws6000

Ive been lurking on the forums for a while and this thread prompted me to register.

The theory that ODs are trying to run opticians out of business with the cost plus dispensing fee approach is rather far fetched.

If anything,I would base this concept of pricing glasses as stupidity on the part of optometrists.

This backwards thinking was one of the reasons that I left Ontario.

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## obxeyeguy

Welcome aboard, and thanks for the welcome opinion.

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## eyemanflying

Some interesting points made on both sides.  The need for opticians to partner with OD's is long overdue.  A professional business partnership would more than satisfy each other's personal goals and financial requirements.  It is also a convenient way to share ideas, knowledge, expertise, overhead costs etc., while serving the public's best interests at hand.
:cheers:

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## Excalibur

> Some interesting points made on both sides. The need for opticians to partner with OD's is long overdue. A professional business partnership would more than satisfy each other's personal goals and financial requirements. It is also a convenient way to share ideas, knowledge, expertise, overhead costs etc., while serving the public's best interests at hand.
> :cheers:


I believe that there should be better working relationships between both groups. There should be limitations, however, on these relationships so that we can optimize patient care and provide professional service based on fudiciary responsibilities to these patients.

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## eyemanflying

There are too many limitations now for opticians and not enough for OD's. You can't tell me that an ophthalmic/optometric assistant is more knowledgeable and experienced than a licenced optician. One thing for sure is the amount of remakes would drop drastically. The OD's function wouldn't change and the addition of an optician under the same roof would definitely optimize patient/client care. I'm not suggesting the optician perform any additional OD duties, just compliment them with providing their dispensing and excellent customer service expertise. If you were to quiz the general public, they wouldn't understand each other's scopes anyway. The most important thing they care about is that they received a proper thorough eye examination, had proper consultation and purchased a great pair of fully functional spectacles fitted by a registered professional, not by one that was delegated and unregistered to perform the task. Also, why does the dispensing fee still get charged when the glasses were not personally or professionally fitted by the OD?

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## Excalibur

> There are too many limitations now for opticians and not enough for OD's. You can't tell me that an ophthalmic/optometric assistant is more knowledgeable and experienced than a licenced optician. One thing for sure is the amount of remakes would drop drastically. The OD's function wouldn't change and the addition of an optician under the same roof would definitely optimize patient/client care. I'm not suggesting the optician perform any additional OD duties, just compliment them with providing their dispensing and excellent customer service expertise. If you were to quiz the general public, they wouldn't understand each other's scopes anyway. The most important thing they care about is that they received a proper thorough eye examination, had proper consultation and purchased a great pair of fully functional spectacles fitted by a registered professional, not by one that was delegated and unregistered to perform the task. Also, why does the dispensing fee still get charged when the glasses were not personally or professionally fitted by the OD?


Several points comments:

Hiring an optician to perform duties within an optometric office may improve patient care in many cases. In some cases, it may not as the OD may have very capable technicians who are able to collect required data and work with the doctor to assist the patient during their visit. These technicians are able to perform the bulk of the procedures and tests required to render appropriate care. In my practice, the remake rate is less than 1%, so hiring an optician may not be that beneficial from this perspective. It may, however, improve sales although I am not quite sure if that would be the case-- perhaps you can enlighten me on how an optician could improve sales in an optometric office. 

As for the appropriateness of charging the fee -- since I supervise the dispensing process, I have no difficulty charging the dispensing fee in my practice. Pharmacist often are not completely involved in the dispensing on a prescription medicine yet charge the full amount of their fee.

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## eyemanflying

We see an average of 5 remakes per day with most done at our cost.  I appreciate your comments and your 1% is impressive.  Perhaps we can exchange trade secrets - your sales will improve and our bottom line will grow.:)

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## Excalibur

> We see an average of 5 remakes per day with most done at our cost.  I appreciate your comments and your 1% is impressive.  Perhaps we can exchange trade secrets - your sales will improve and our bottom line will grow.:)


5/remakes per day easily translates to over 1000/yr. That is extremely high and unacceptable. We rarely have 1/month.

Are these prescriptions from an rx outside your business? Or are they written from a doctor who comes into your shop to refract only? Please advise.

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## eyemanflying

They come in from across the country.  If it were one doc on-site, I would be rethinking the long term business plan.  There are good and bad in every profession.

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## Excalibur

> They come in from across the country.  If it were one doc on-site, I would be rethinking the long term business plan.  There are good and bad in every profession.


I hope that a 5 remake/day rate is atypical for optical shops. Somehow I doubt that this is average. If your re-do rate is particularly high from a certain practitioner, you may wish to contact his/her regulatory college and post a complaint.

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## eyemanflying

The remakes rarely consist of Rx changes.  They are 90% of the time dispensing errors, wrong heights, wrong monocular PD's etc., and always on progressives.  In the event I do have to call and inquire, the dispensing on these remakes is always done by the assistants, not the OD.  There have even been cases where they want to try multiple brands of progressives before they decide which one works best???  There is definitely a training opportunity out there.  Glad to see that yours is under control.

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## Excalibur

> The remakes rarely consist of Rx changes.  They are 90&#37; of the time dispensing errors, wrong heights, wrong monocular PD's etc., and always on progressives.  In the event I do have to call and inquire, the dispensing on these remakes is always done by the assistants, not the OD.  There have even been cases where they want to try multiple brands of progressives before they decide which one works best???  There is definitely a training opportunity out there.  Glad to see that yours is under control.


It does not appear then that your situation is costing your business. This is a perfect opportunity to grow your dispensing business due to someone else's incompetence. If they are making these errors, it would be quite clear that these patients should see you next for specs instead of that practitioner's practice. I do, however, believe that your situation is highly atypical and that most private OD practices have a very high dispensing success rate in their practices. Unfortunately, there are a few of these practices that have disastrous dispensing success rates and they can never become successful.

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## eyemanflying

Without getting into detail, I receive orders as part of a national dispensing program and is not retail based.

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## Excalibur

> Without getting into detail, I receive orders as part of a national dispensing program and is not retail based.


I am somewhat puzzled with your explanation.

Are you receiving orders that are constantly being changed by the staff? If so, it sounds like the dispensing program is being penalized by the inefficiency of those practices that are doing so poorly with their technical measurements (PDs, seg hts, etc). The dispensing program is bearing the cost of these changes, and as such they should discuss this with the offending practices (without getting anybody's nose out of joint) as it hurting their bottom line. One remake/day per practice is very high... but five? WOW!

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## eyemanflying

Its a bit more complicated, and unfortunately can't discuss on a public forum.  Not quite yet anyway....

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## MarcE

Excalibur has:
A $1M+ practice, (but nets less than $250K) 
Less than a 1% remake rate,
no optician on-site and doesn't need to ever consult with one,
he "supervise(s) the dispensing process",

Truly amazing

Do you also supervise the lens ordering and choices?  Do you answer the lab's questions when they call?  Do you calculate "computer" Rxs?  Do you calculate the lens thickness for patients that ask which one is thicker between poly at 1.0ct or 1.67 at 1.5ct; or 1.67 transitions at a 1.9ct?

I just don't understand who manages the dispensary when you have moved on to the next patient.  You either have someone that is taking care of these issues I cited above, or you are offering abysmal optical services.

If you have someone in your office that performs these duties, then you have an "optician", whether they are licensed or not.  No need to badmouth these mere tradesmen when they are running your office while you are locked in a dark room.  You rely on these this trade to make you money while you are performing exams.  

You are showing a bit of misplaced disrespect.

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## Excalibur

> Excalibur has:
> A $1M+ practice, (but nets less than $250K) 
> Less than a 1% remake rate,
> no optician on-site and doesn't need to ever consult with one,
> he "supervise(s) the dispensing process",
> 
> Truly amazing
> 
> Do you also supervise the lens ordering and choices?  Do you answer the lab's questions when they call?  Do you calculate "computer" Rxs?  Do you calculate the lens thickness for patients that ask which one is thicker between poly at 1.0ct or 1.67 at 1.5ct; or 1.67 transitions at a 1.9ct?
> ...


and a Happy New Year to you too! :cheers:

this thread is so 2007!

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## tmorse

> As for the appropriateness of charging the fee -- since I supervise the dispensing process, I have no difficulty charging the dispensing fee in my practice. Pharmacist often are not completely involved in the dispensing on a prescription medicine yet charge the full amount of their fee.


Pharmacists and their pharmacy techs are in constant floor contact with each other and have immediate access to each other for questions, etc. 

MarcE asks a reasonable question... how do you manage such effective supervision in your office? :Confused:

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## Chris Ryser

> *Most of our lenses are premium-branded including free-form progressives and the newest coatings.*


If an optometrist decides to start selling discontinued frames he can buy at rock bottom prices, (good quality), uses non brand lenses, ( good quality), reduces his lab cost by doing some easy to do operationslike tinting, UV and or scratchresistant treatments himself...............the cost of the finished product has been reduced by at least 70% and is of perfect quality.

How would he now handle the sale of the end product which has a cost factor that has become very low, but is of good quality ?

1.   Sell at cost plus fee

2    Or sell at cost plus inflated fee ?

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## eyemanflying

Isn't it always #2 anyway? I'm sure that frame/lab discounts are rarely passed on to the patient/client. It would be near impossible to survive on dispensing fees alone.

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## renee1111

> do Ontario opticians feel threatened by Ontario optometrists' dispensing fee model?


I guess I'm a bit late answering this question, because it seems the conversation has taken a different turn. So back to the original question, my answer would have to be no, I do not feel threatened by the dispensing fee model. All the Optometrist in my area have heavily inflated price lists (because of the large discounts they receive from suppliers.) The discounts start anywhere from 30 to 60% and are not passed onto the patient. So our price is much lower than all the OD's in town. People are quite surprised that we offer the same products (ie; nikon and Sola) as OD's, but at a much better price. :o

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## eyemanflying

I think that top notch service and product selection will always leave pricing in the back seat.

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## renee1111

> I think that top notch service and product selection will always leave pricing in the back seat.


I completely agree that top notch service is the most important issue and I certainly strive to achieve it. Although, I must admit that pricing also plays a large role in my community. The market is saturated with discount retailers and by offering the utmost value to my customers, I feel that also adds to the overall service.

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## eyemanflying

Sounds like your market is the Trenton or Napanee area.

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## renee1111

> Sounds like your market is the Trenton or Napanee area.


Not quite, more like the sudbury area.  :o

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## eyemanflying

Tough market with zero dispensing fees for Inco's safety to boot.:)

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## renee1111

> Tough market with zero dispensing fees for Inco's safety to boot.:)


yah, no doubt...but at least it gives us a chance to "show what we're made of" (so to speak) when it comes to service. We have had whole families come up from as far as Kapuskasing and Ville marie (QU).
So at least it worth the effort on that front.  :Rolleyes:

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## tmorse

> Not quite, more like the sudbury area. :o


*Omer Gagnon* Opticians still around?

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## eyemanflying

> yah, no doubt...but at least it gives us a chance to "show what we're made of" (so to speak) when it comes to service. We have had whole families come up from as far as Kapuskasing and Ville marie (QU).
> So at least it worth the effort on that front.


I hear ya, at least they have vision care benefits. Nothing like muddy boots, a union mentality and zero dispensing fee to make your day! Things will change within the next year or so with that contract as 'they' (without naming the safety company) were recently acquired and changes are imminent. Stay tuned...  :Confused:

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## Chris Ryser

> *Omer Gagnon Opticians still around?*


Diaspeared a few years ago.

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## renee1111

> *Omer Gagnon* Opticians still around?


Yes, but he's retired and his daughter ownes Gagnon Opticians now. They are the nicest people!

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