MEDICARE: DR. BRIAN J SNYDER 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	2880	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1609871557
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIAN J SNYDER O.D.

Provider Business Mailing Address
First Line	:	1887 MONTREAL AVE
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55116-2036
Country	:	US
Telephone Number	:	612-619-6038
Fax Number	:

Provider Business Practice Location Address
First Line	:	757 CLEVELAND AVE S
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55116-1302
Country	:	US
Telephone Number	:	651-699-5400
Fax Number	:	651-789-3155

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

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	09/19/2013

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