Healthcare Provider Details

I. General information

NPI: 1952620130
Provider Name (Legal Business Name): ALYSSA MARIE SNYDER O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2010
Last Update Date: 06/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1305 E COLLEGE DR
MARSHALL MN
56258-2011
US

IV. Provider business mailing address

1305 E COLLEGE DR
MARSHALL MN
56258-2011
US

V. Phone/Fax

Practice location:
  • Phone: 507-337-4007
  • Fax: 844-893-8311
Mailing address:
  • Phone: 507-337-4007
  • Fax: 507-540-0053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3204
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: