Provider Demographics
NPI:1003859786
Name:SCHNEIDERHAN, JOSEPH ANTHONY (OD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:ANTHONY
Last Name:SCHNEIDERHAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 MINNESOTA AVE W STE 102
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:56334-1558
Mailing Address - Country:US
Mailing Address - Phone:320-334-3264
Mailing Address - Fax:320-334-3182
Practice Address - Street 1:16 MINNESOTA AVE W STE 102
Practice Address - Street 2:
Practice Address - City:GLENWOOD
Practice Address - State:MN
Practice Address - Zip Code:56334-1558
Practice Address - Country:US
Practice Address - Phone:320-334-3264
Practice Address - Fax:320-334-3182
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2417152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN597816500Medicaid
MNU37290Medicare UPIN
MN597816500Medicaid