Provider Demographics
NPI:1922032697
Name:SNIDER & ASSOCIATES OPTOMETRY, PC
Entity Type:Organization
Organization Name:SNIDER & ASSOCIATES OPTOMETRY, PC
Other - Org Name:SNIDER & SWOPES OPTOMETRY, PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:D
Authorized Official - Last Name:SNIDER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:816-884-5212
Mailing Address - Street 1:P.O. BOX 446
Mailing Address - Street 2:
Mailing Address - City:HARRISONVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64701
Mailing Address - Country:US
Mailing Address - Phone:816-884-5212
Mailing Address - Fax:816-884-3313
Practice Address - Street 1:2100 E. MECHANIC ST.
Practice Address - Street 2:
Practice Address - City:HARRISONVILLE
Practice Address - State:MO
Practice Address - Zip Code:64701
Practice Address - Country:US
Practice Address - Phone:816-884-5212
Practice Address - Fax:816-884-3313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
152W00000X
MOT02305152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO5650830001Medicare NSC
MOW720000Medicare PIN
MOX95254Medicare UPIN
X95254Medicare UPIN