MEDICARE: MATTHEW A. 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	332H00000X	Eyewear Supplier	2080	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4C965GA	OTHER	MN	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1649456641
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MATTHEW A. GAHN, O.D.

Provider Business Mailing Address
First Line	:	314 GRANT AVE
Second Line	:
City	:	EVELETH
State	:	MN
Zip	:	55734-1524
Country	:	US
Telephone Number	:	218-744-4528
Fax Number	:

Provider Business Practice Location Address
First Line	:	314 GRANT AVE
Second Line	:
City	:	EVELETH
State	:	MN
Zip	:	55734-1524
Country	:	US
Telephone Number	:	218-744-4528
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MATTHEW ARNOLD GAHN
Credential	:	O.D.
Telephone Number	:	218-744-4528

Provider Enumeration Date	:	01/21/2008
Last Update Date	:	02/18/2009

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