Healthcare Provider Details

I. General information

NPI: 1760737746
Provider Name (Legal Business Name): MRS. JENNIFER MARION SNYDER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER MARION SMITH O.D.

II. Dates (important events)

Enumeration Date: 07/17/2012
Last Update Date: 11/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 MADISON AVE
MEMPHIS TN
38104-2211
US

IV. Provider business mailing address

1245 MADISON AVE
MEMPHIS TN
38104-2211
US

V. Phone/Fax

Practice location:
  • Phone: 901-722-3250
  • Fax: 901-722-3347
Mailing address:
  • Phone: 901-722-3250
  • Fax: 901-722-3347

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3060
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: