Provider Demographics
NPI:1063460822
Name:SNIVELY, JAMES O (OD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:O
Last Name:SNIVELY
Suffix:
Gender:M
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:PO BOX 189
Mailing Address - Street 2:
Mailing Address - City:CLARION
Mailing Address - State:IA
Mailing Address - Zip Code:50525-1439
Mailing Address - Country:US
Mailing Address - Phone:515-532-3630
Mailing Address - Fax:515-532-6683
Practice Address - Street 1:219 N MAIN
Practice Address - Street 2:
Practice Address - City:CLARION
Practice Address - State:IA
Practice Address - Zip Code:50525-1439
Practice Address - Country:US
Practice Address - Phone:515-532-3630
Practice Address - Fax:515-532-6683
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1493152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0057109Medicaid
IA0057109Medicaid
IA05710Medicare ID - Type Unspecified