Provider Demographics
NPI:1649456641
Name:MATTHEW A. GAHN, O.D.
Entity type:Organization
Organization Name:MATTHEW A. GAHN, O.D.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:ARNOLD
Authorized Official - Last Name:GAHN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:218-744-4528
Mailing Address - Street 1:314 GRANT AVE
Mailing Address - Street 2:
Mailing Address - City:EVELETH
Mailing Address - State:MN
Mailing Address - Zip Code:55734-1524
Mailing Address - Country:US
Mailing Address - Phone:218-744-4528
Mailing Address - Fax:
Practice Address - Street 1:314 GRANT AVE
Practice Address - Street 2:
Practice Address - City:EVELETH
Practice Address - State:MN
Practice Address - Zip Code:55734-1524
Practice Address - Country:US
Practice Address - Phone:218-744-4528
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-21
Last Update Date:2009-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2080332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN4C965GAOtherBLUE CROSS BLUE SHIELD
MN4C965GAOtherBLUE CROSS BLUE SHIELD