Provider Demographics
NPI:1922387265
Name:SNYDER, JULIE LYNN MARSH (OD)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:LYNN MARSH
Last Name:SNYDER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:LYNN
Other - Last Name:MARSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:201 E LAUREL BLVD
Mailing Address - Street 2:
Mailing Address - City:POTTSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17901-2534
Mailing Address - Country:US
Mailing Address - Phone:570-628-4444
Mailing Address - Fax:570-628-3088
Practice Address - Street 1:201 E. LAUREL BLVD
Practice Address - Street 2:
Practice Address - City:POTTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17901
Practice Address - Country:US
Practice Address - Phone:570-628-4444
Practice Address - Fax:570-628-3088
Is Sole Proprietor?:No
Enumeration Date:2011-08-04
Last Update Date:2016-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG002522152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102623780Medicaid
PA224995SDHMedicare PIN
PA1205878915OtherGROUP NPI
PA224995SDHMedicare PIN