MEDICARE: DR. MATTHEW STEPHEN BAUMGARDNER 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
1	152W00000X	Optometrist	3077	MN

General Provider Information

NPI Number	:	1518167576
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MATTHEW STEPHEN BAUMGARDNER O.D.

Provider Business Mailing Address
First Line	:	680 COUNTY ROAD 10 NE
Second Line	:
City	:	BLAINE
State	:	MN
Zip	:	55434-2329
Country	:	US
Telephone Number	:	763-785-2200
Fax Number	:

Provider Business Practice Location Address
First Line	:	6500 PENN AVE S
Second Line	:
City	:	RICHFIELD
State	:	MN
Zip	:	55423-1143
Country	:	US
Telephone Number	:	612-798-1720
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/18/2007
Last Update Date	:	05/18/2016

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