Provider Demographics
NPI:1073863965
Name:SNYDER, KYLE DANIEL (OD)
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:DANIEL
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 1:234 LINCOLNSHIRE LN
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-1921
Mailing Address - Country:US
Mailing Address - Phone:708-265-1957
Mailing Address - Fax:
Practice Address - Street 1:22401 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:RICHTON PARK
Practice Address - State:IL
Practice Address - Zip Code:60471-2062
Practice Address - Country:US
Practice Address - Phone:708-898-9994
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-18
Last Update Date:2019-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046010620152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist