Basic Information
Provider Information
NPI: 1063132694
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SNOW
FirstName: LINDSAY
MiddleName: ERIN
NamePrefix: DR.
NameSuffix:  
Credential: OD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 332 BUSH ST
Address2:  
City: IRONDALE
State: AL
PostalCode: 352103216
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 332 BUSH ST
Address2:  
City: IRONDALE
State: AL
PostalCode: 352103216
CountryCode: US
TelephoneNumber: 2059752020
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/01/2022
LastUpdateDate: 09/01/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 07/10/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
152W00000XS-F13-TA-C82ALY Eye and Vision Services ProvidersOptometrist 

No ID Information.


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