Provider Demographics
NPI:1225400971
Name:SNEAD, LORRAINE (OD)
Entity Type:Individual
Prefix:
First Name:LORRAINE
Middle Name:
Last Name:SNEAD
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 POLE HILL RD
Mailing Address - Street 2:
Mailing Address - City:GOODLETTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37072-8446
Mailing Address - Country:US
Mailing Address - Phone:615-772-1555
Mailing Address - Fax:
Practice Address - Street 1:1000 RIVERGATE PKWY
Practice Address - Street 2:
Practice Address - City:GOODLETTSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37072-2447
Practice Address - Country:US
Practice Address - Phone:615-772-1555
Practice Address - Fax:615-859-7801
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-21
Last Update Date:2015-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2308152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist