Provider Demographics
NPI:1942525225
Name:SNODGRASS FAMILY EYECARE, PLLC
Entity Type:Organization
Organization Name:SNODGRASS FAMILY EYECARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JANE
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:SNODGRASS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:515-223-9595
Mailing Address - Street 1:1250 NW 128TH ST
Mailing Address - Street 2:SUITE 150
Mailing Address - City:CLIVE
Mailing Address - State:IA
Mailing Address - Zip Code:50325-7432
Mailing Address - Country:US
Mailing Address - Phone:515-223-9595
Mailing Address - Fax:515-223-9792
Practice Address - Street 1:1250 NW 128TH ST
Practice Address - Street 2:SUITE 150
Practice Address - City:CLIVE
Practice Address - State:IA
Practice Address - Zip Code:50325-7432
Practice Address - Country:US
Practice Address - Phone:515-223-9595
Practice Address - Fax:515-223-9792
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-30
Last Update Date:2010-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1994332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA6361810001Medicare NSC