Provider Demographics
NPI:1720026321
Name:SNEDDON, GEOFFREY M (OD)
Entity Type:Individual
Prefix:
First Name:GEOFFREY
Middle Name:M
Last Name:SNEDDON
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 1:1200 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:2006-06-04
Last Update Date:2008-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901004159152W00000X
IL046-009938152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
900G510070OtherBCBS
MI944553494Medicaid
MI944564620Medicaid
IL0814870010OtherMEDICARE NSC NUMBER
IL0814870011OtherMEDICARE NSC NUMBER
IL0814870030OtherMEDICARE NSC NUMBER
IL046009938Medicaid
129094OtherHEALTH ALLIANCE
IL0814870023OtherMEDICARE NSC NUMBER
IL0814870001OtherMEDICARE NSC NUMBER
217445OtherEYEMED
ILP00434355OtherMEDICARE RAILROAD
ILP00434355OtherMEDICARE RAILROAD
MI944553494Medicaid
IL046009938Medicaid
M60130Medicare PIN