Provider Demographics
NPI:1063851822
Name:SNELL, TITUS (ABOC)
Entity Type:Individual
Prefix:MR
First Name:TITUS
Middle Name:
Last Name:SNELL
Suffix:
Gender:M
Credentials:ABOC
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 923
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MS
Mailing Address - Zip Code:39060-0923
Mailing Address - Country:US
Mailing Address - Phone:601-260-1292
Mailing Address - Fax:601-510-9191
Practice Address - Street 1:1604 BEVERLY DR
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MS
Practice Address - Zip Code:39056-3509
Practice Address - Country:US
Practice Address - Phone:601-260-1292
Practice Address - Fax:601-510-9191
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-14
Last Update Date:2013-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FC0800XEye and Vision Services ProvidersTechnician/TechnologistContact Lens