Provider Demographics
NPI:1578706966
Name:RICHARD P. SNYDER, O.D.
Entity Type:Organization
Organization Name:RICHARD P. SNYDER, O.D.
Other - Org Name:APPLEGATE EYE CENTER, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:SNYDER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:541-935-3332
Mailing Address - Street 1:PO BOX 159
Mailing Address - Street 2:
Mailing Address - City:VENETA
Mailing Address - State:OR
Mailing Address - Zip Code:97487-0159
Mailing Address - Country:US
Mailing Address - Phone:541-935-3332
Mailing Address - Fax:
Practice Address - Street 1:88267 N TERRITORIAL RD
Practice Address - Street 2:
Practice Address - City:VENETA
Practice Address - State:OR
Practice Address - Zip Code:97487-9499
Practice Address - Country:US
Practice Address - Phone:541-935-3332
Practice Address - Fax:541-935-5710
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RICHARD P. SNYDER, O.D.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-04-14
Last Update Date:2009-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1510ATI332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR222711Medicaid
ORT68149Medicare UPIN
OR0832710001Medicare NSC