Healthcare Provider Details

I. General information

NPI: 1609871557
Provider Name (Legal Business Name): BRIAN J SNYDER O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 09/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

757 CLEVELAND AVE S
SAINT PAUL MN
55116-1302
US

IV. Provider business mailing address

1887 MONTREAL AVE
SAINT PAUL MN
55116-2036
US

V. Phone/Fax

Practice location:
  • Phone: 651-699-5400
  • Fax: 651-789-3155
Mailing address:
  • Phone: 612-619-6038
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2880
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: