Provider Demographics
NPI:1053474254
Name:SNYDER, WAYNE EARLE (MD)
Entity Type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:EARLE
Last Name:SNYDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1225 4TH ST NE
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:SD
Mailing Address - Zip Code:57201-1204
Mailing Address - Country:US
Mailing Address - Phone:605-882-4175
Mailing Address - Fax:605-882-2962
Practice Address - Street 1:1225 4TH ST NE
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:SD
Practice Address - Zip Code:57201-1204
Practice Address - Country:US
Practice Address - Phone:605-882-4175
Practice Address - Fax:605-882-2962
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1496207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6300380Medicaid
SD1496OtherSTATE LICENSE
SDD25614Medicare UPIN
SD6300380Medicaid