MEDICARE: DR. JENNA ROSE KRYDER O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	3323	MN

General Provider Information

NPI Number	:	1225472244
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENNA ROSE KRYDER O.D.

Provider Business Mailing Address
First Line	:	1610 BROADWAY ST
Second Line	:
City	:	ALEXANDRIA
State	:	MN
Zip	:	56308
Country	:	US
Telephone Number	:	320-763-4321
Fax Number	:	320-763-6921

Provider Business Practice Location Address
First Line	:	1610 BROADWAY ST
Second Line	:
City	:	ALEXANDRIA
State	:	MN
Zip	:	56308-2708
Country	:	US
Telephone Number	:	320-763-4321
Fax Number	:	320-763-6921

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/21/2013
Last Update Date	:	06/13/2017

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