Provider Demographics
NPI:1306981956
Name:SCHNEIDERHAN, DAVID JOHN (CERTIFIED OPTICIAN)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:JOHN
Last Name:SCHNEIDERHAN
Suffix:
Gender:M
Credentials:CERTIFIED OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3212 DARLING DR NW
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:MN
Mailing Address - Zip Code:56308-8635
Mailing Address - Country:US
Mailing Address - Phone:320-846-5507
Mailing Address - Fax:
Practice Address - Street 1:610 30TH AVE W STE 200
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:MN
Practice Address - Zip Code:56308-3426
Practice Address - Country:US
Practice Address - Phone:320-763-7055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician