Provider Demographics
NPI:1346242955
Name:SNYDER, DUANE (OD)
Entity Type:Individual
Prefix:DR
First Name:DUANE
Middle Name:
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 1:500 DAVISON RD
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14094-4021
Mailing Address - Country:US
Mailing Address - Phone:716-434-8063
Mailing Address - Fax:716-434-2845
Practice Address - Street 1:500 DAVISON RD
Practice Address - Street 2:
Practice Address - City:LOCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14094-4021
Practice Address - Country:US
Practice Address - Phone:716-434-8063
Practice Address - Fax:716-434-2845
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-12
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV004475-1152W00000X
PAOE-006323-P152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DD6223Medicare ID - Type Unspecified
U27699Medicare UPIN