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NPI Code Detail

MEDICARE: MATTHEW WILLIAM GRANGE O.D.

MEDICARE: MATTHEW WILLIAM GRANGE O.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometrist3020000MN
2152WC0802XCorneal and Contact Management Optometrist3020000MN
3152WP0200XPediatric Optometrist3020000MN
4152WS0006XSports Vision Optometrist3020000MN
5152WX0102XOccupational Vision Optometrist3020000MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12425242OTHERAMERICAS PPO
286G79GROTHERMNBLUE CROSS BLUE SHIELD
3XX1901044875OTHERMNPREFERRED ONE
42203255OTHERMNMEDICA
5HP60833OTHERMNHEALTH PARTNERS
6182595OTHERMNUCARE

General Provider Information

NPI Number : 1427146372
Entity Type Code : Individual
Provider Name (Legal Business Name) : MATTHEW WILLIAM GRANGE O.D.
Provider Business Mailing Address
First Line : 1340 DUCKWOOD DR
Second Line : SUITE 14
City : EAGAN
State : MN
Zip : 55123-2324
Country : US
Telephone Number : 651-452-0344
Fax Number : 651-452-1564
Provider Business Practice Location Address
First Line : 1340 DUCKWOOD DR
Second Line : SUITE 14
City : EAGAN
State : MN
Zip : 55123-2324
Country : US
Telephone Number : 651-452-0344
Fax Number : 651-452-1564
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/10/2006
Last Update Date : 09/11/2025

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Directions to “ MATTHEW WILLIAM GRANGE O.D.” Practice Location

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