Provider Demographics
NPI:1396951646
Name:GAHAGEN, JAMES MARTIN (OD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:MARTIN
Last Name:GAHAGEN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:95360 OVERSEAS HWY
Mailing Address - Street 2:SUITE 3
Mailing Address - City:KEY LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33037-2038
Mailing Address - Country:US
Mailing Address - Phone:305-852-7517
Mailing Address - Fax:
Practice Address - Street 1:95360 OVERSEAS HWY
Practice Address - Street 2:SUITE 3
Practice Address - City:KEY LARGO
Practice Address - State:FL
Practice Address - Zip Code:33037-2038
Practice Address - Country:US
Practice Address - Phone:305-852-7517
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC2041152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL20140Medicare UPIN