Provider Demographics
NPI:1417520644
Name:SNYDER, MICHAELE DORIES (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHAELE
Middle Name:DORIES
Last Name:SNYDER
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 1:4780 KINTORE DR
Mailing Address - Street 2:
Mailing Address - City:NOLENSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37135-2928
Mailing Address - Country:US
Mailing Address - Phone:951-265-3357
Mailing Address - Fax:
Practice Address - Street 1:1100 JOHNSON FY RD NE STE 108
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1733
Practice Address - Country:US
Practice Address - Phone:404-531-9988
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-24
Last Update Date:2021-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT003345152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist