Provider Demographics
NPI:1689233447
Name:SCHNEIDER, KATELYN LANE (OD)
Entity Type:Individual
Prefix:
First Name:KATELYN
Middle Name:LANE
Last Name:SCHNEIDER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46788 221ST ST
Mailing Address - Street 2:
Mailing Address - City:BROOKINGS
Mailing Address - State:SD
Mailing Address - Zip Code:57006-7161
Mailing Address - Country:US
Mailing Address - Phone:605-695-2084
Mailing Address - Fax:
Practice Address - Street 1:110 EVERGREEN SQ SW
Practice Address - Street 2:
Practice Address - City:PINE CITY
Practice Address - State:MN
Practice Address - Zip Code:55063-2000
Practice Address - Country:US
Practice Address - Phone:320-629-7262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-06
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3615152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist