Provider Demographics
NPI:1659434926
Name:SNEDDON, SHEILA A (OD)
Entity Type:Individual
Prefix:
First Name:SHEILA
Middle Name:A
Last Name:SNEDDON
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 1:1200 W DEYOUNG ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IL
Mailing Address - Zip Code:62959-4437
Mailing Address - Country:US
Mailing Address - Phone:618-993-5686
Mailing Address - Fax:618-997-6250
Practice Address - Street 1:1200 W DEYOUNG ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IL
Practice Address - Zip Code:62959-4437
Practice Address - Country:US
Practice Address - Phone:618-993-5686
Practice Address - Fax:618-997-6250
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2009-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901004213152W00000X
IL046-010028152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
900A210070OtherBCBS
MI944696844Medicaid
IL0814870001OtherMEDICARE NSC NUMBER
IL0814870023OtherMEDICARE NSC NUMBER
IL0814870026OtherMEDICARE NSC NUMBER
IL0814870010OtherMEDICARE NSC NUMBER
IL0814870011OtherMEDICARE NSC NUMBER
ILP00650599 CA2196OtherMEDICARE RAILROAD
MI900G510070OtherBCBS
IL0814870029OtherMEDICARE NSC NUMBER
IL0814870024OtherMEDICARE NSC NUMBER
IL046010028Medicaid
IL0814870004OtherMEDICARE NSC NUMBER
IL0028OtherEYEMED
IL046010028Medicaid
900A210070OtherBCBS
IL0814870024OtherMEDICARE NSC NUMBER
V00105Medicare UPIN