Provider Demographics
NPI:1548241938
Name:GAHN, MATTHEW ARNOLD (OD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:ARNOLD
Last Name:GAHN
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 1:420 GRANT AVENUE
Mailing Address - Street 2:
Mailing Address - City:EVELETH
Mailing Address - State:MN
Mailing Address - Zip Code:55734-1311
Mailing Address - Country:US
Mailing Address - Phone:218-744-4528
Mailing Address - Fax:218-744-1899
Practice Address - Street 1:420 GRANT AVENUE
Practice Address - Street 2:
Practice Address - City:EVELETH
Practice Address - State:MN
Practice Address - Zip Code:55734-1311
Practice Address - Country:US
Practice Address - Phone:218-744-4528
Practice Address - Fax:218-744-1899
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-11
Last Update Date:2015-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2080152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN671725000Medicaid
MN3K204GAOtherBLUE CROSS BLUE SHIELD
MN3K205GAOtherBLUE CROSS BLUE SHIELD
MNT01448Medicare UPIN
MN419000167Medicare ID - Type Unspecified