Provider Demographics
NPI:1548373517
Name:SCHANZENBACH, JOYCE MARIE (OD)
Entity type:Individual
Prefix:
First Name:JOYCE
Middle Name:MARIE
Last Name:SCHANZENBACH
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:JOYCE
Other - Middle Name:MARIE
Other - Last Name:SPIRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:5540 OVERLOOK CIR SE
Mailing Address - Street 2:
Mailing Address - City:PRIOR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55372-3375
Mailing Address - Country:US
Mailing Address - Phone:952-447-2166
Mailing Address - Fax:
Practice Address - Street 1:8101 OLD CARRIAGE CT
Practice Address - Street 2:
Practice Address - City:SHAKOPEE
Practice Address - State:MN
Practice Address - Zip Code:55379-3155
Practice Address - Country:US
Practice Address - Phone:952-445-8092
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2603152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN16876OtherSPECTERA
MN201L8SCOtherBCBS
MN22-01929OtherMEDICA
MN244331019179OtherPREFERREDONE
MN819003800Medicaid