Provider Demographics
NPI:1528033677
Name:SKAHAN, MATTHEW DENNIS (OD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:DENNIS
Last Name:SKAHAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 847
Mailing Address - Street 2:424 N WASHINGTON
Mailing Address - City:IOLA
Mailing Address - State:KS
Mailing Address - Zip Code:66749-0847
Mailing Address - Country:US
Mailing Address - Phone:620-365-2108
Mailing Address - Fax:620-365-2522
Practice Address - Street 1:424 N WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:IOLA
Practice Address - State:KS
Practice Address - Zip Code:66749-2353
Practice Address - Country:US
Practice Address - Phone:620-365-2108
Practice Address - Fax:620-365-2522
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1631152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100453900BMedicaid
KSP00124573OtherRAILROAD MEDICARE
KS512970OtherFIRSTGUARD
KSU92124Medicare UPIN