Provider Demographics
NPI:1487650628
Name:SNYDER, MATTHEW C (OD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:C
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:PO BOX 405
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:TX
Mailing Address - Zip Code:77356-0405
Mailing Address - Country:US
Mailing Address - Phone:936-582-4200
Mailing Address - Fax:936-582-2323
Practice Address - Street 1:123 BLUE HERON DR
Practice Address - Street 2:STE 103
Practice Address - City:MONTGOMERY
Practice Address - State:TX
Practice Address - Zip Code:77316-3192
Practice Address - Country:US
Practice Address - Phone:936-582-4200
Practice Address - Fax:936-582-2323
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-22
Last Update Date:2007-07-08
Deactivation Date:2006-03-15
Deactivation Code:
Reactivation Date:2006-03-21
Provider Licenses
StateLicense IDTaxonomies
TX5751TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00463PMedicare ID - Type Unspecified
TXU82543Medicare UPIN