Provider Demographics
NPI:1073720975
Name:SNYDER, TED ANDREW (OD)
Entity Type:Individual
Prefix:DR
First Name:TED
Middle Name:ANDREW
Last Name:SNYDER
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 1:7567 CENTRAL PARKE BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-6852
Mailing Address - Country:US
Mailing Address - Phone:513-770-4220
Mailing Address - Fax:513-770-4120
Practice Address - Street 1:7567 CENTRAL PARKE BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-6852
Practice Address - Country:US
Practice Address - Phone:513-770-4220
Practice Address - Fax:513-770-4120
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2014-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4147152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4147OtherSTATE OPTOMETRY LICENSE
OHT1495OtherOPT. THERAPEUTIC LICENSE
OHU38733Medicare UPIN
OHSN0723021Medicare ID - Type Unspecified