Provider Demographics
NPI:1558473595
Name:KAHAN, DAVID (OD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:KAHAN
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 1:436 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:METHUEN
Mailing Address - State:MA
Mailing Address - Zip Code:01844-2061
Mailing Address - Country:US
Mailing Address - Phone:978-687-3220
Mailing Address - Fax:978-794-1457
Practice Address - Street 1:436 BROADWAY
Practice Address - Street 2:
Practice Address - City:METHUEN
Practice Address - State:MA
Practice Address - Zip Code:01844-2061
Practice Address - Country:US
Practice Address - Phone:978-687-3220
Practice Address - Fax:978-794-1457
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2009-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2437152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA998281OtherNETHEALTH
31707OtherCIGNA
MAW15222OtherBLUE CROSS BLUE SHIELD
MA707195OtherTUFTS
MA139558Medicare PIN
MA707195OtherTUFTS