Provider Demographics
NPI:1376733949
Name:KUNKEL-SNYDER OPTOMETRIC, P.C
Entity type:Organization
Organization Name:KUNKEL-SNYDER OPTOMETRIC, P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:C
Authorized Official - Last Name:KUNKEL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:605-882-4175
Mailing Address - Street 1:1225 4TH ST NE
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:SD
Mailing Address - Zip Code:57201-1204
Mailing Address - Country:US
Mailing Address - Phone:605-882-4175
Mailing Address - Fax:605-882-2962
Practice Address - Street 1:1225 4TH ST NE
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:SD
Practice Address - Zip Code:57201-1204
Practice Address - Country:US
Practice Address - Phone:605-882-4175
Practice Address - Fax:605-882-2962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-30
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD643152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5946240001Medicare NSC
SD101898Medicare PIN