Provider Demographics
NPI:1013130939
Name:C. RICHARD SNIVELY, JR., O.D.,P.C.
Entity Type:Organization
Organization Name:C. RICHARD SNIVELY, JR., O.D.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:SNIVELY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:703-938-7633
Mailing Address - Street 1:120 BEULAH RD NE
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22180-4745
Mailing Address - Country:US
Mailing Address - Phone:703-938-7633
Mailing Address - Fax:703-938-4407
Practice Address - Street 1:120 BEULAH RD NE
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22180-4745
Practice Address - Country:US
Practice Address - Phone:703-938-7633
Practice Address - Fax:703-938-4407
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000132152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
T31-100Medicare UPIN
SN403422Medicare ID - Type Unspecified