Provider Demographics
NPI:1578556734
Name:SNAVELY-DICKOW, PAMELA L (OD)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:L
Last Name:SNAVELY-DICKOW
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 1:65 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LITITZ
Mailing Address - State:PA
Mailing Address - Zip Code:17543-1941
Mailing Address - Country:US
Mailing Address - Phone:717-626-8100
Mailing Address - Fax:717-626-0389
Practice Address - Street 1:65 E MAIN ST
Practice Address - Street 2:
Practice Address - City:LITITZ
Practice Address - State:PA
Practice Address - Zip Code:17543-1941
Practice Address - Country:US
Practice Address - Phone:717-626-8100
Practice Address - Fax:717-626-0389
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000016152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA109027Medicare ID - Type UnspecifiedGROUP #
PA0300830001Medicare NSC
PAU65690Medicare UPIN
PA895456FGXMedicare ID - Type Unspecified