Healthcare Provider Details

I. General information

NPI: 1649456641
Provider Name (Legal Business Name): MATTHEW A. GAHN, O.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2008
Last Update Date: 02/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314 GRANT AVE
EVELETH MN
55734-1524
US

IV. Provider business mailing address

314 GRANT AVE
EVELETH MN
55734-1524
US

V. Phone/Fax

Practice location:
  • Phone: 218-744-4528
  • Fax:
Mailing address:
  • Phone: 218-744-4528
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number2080
License Number StateMN

VIII. Authorized Official

Name: DR. MATTHEW ARNOLD GAHN
Title or Position: OWNER
Credential: O.D.
Phone: 218-744-4528