MEDICARE: DR. MATTHEW ARNOLD GAHN 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	2080	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	3K204GA	OTHER	MN	BLUE CROSS BLUE SHIELD
3	3K205GA	OTHER	MN	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1548241938
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MATTHEW ARNOLD GAHN O.D.

Provider Business Mailing Address
First Line	:	420 GRANT AVENUE
Second Line	:
City	:	EVELETH
State	:	MN
Zip	:	55734-1311
Country	:	US
Telephone Number	:	218-744-4528
Fax Number	:	218-744-1899

Provider Business Practice Location Address
First Line	:	420 GRANT AVENUE
Second Line	:
City	:	EVELETH
State	:	MN
Zip	:	55734-1311
Country	:	US
Telephone Number	:	218-744-4528
Fax Number	:	218-744-1899

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

Provider Enumeration Date	:	11/11/2005
Last Update Date	:	08/06/2015

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