Provider Demographics
NPI:1720079361
Name:SNIPES, STEPHEN M (OD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:M
Last Name:SNIPES
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2450 KANNAPOLIS HWY
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-4202
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2450 KANNAPOLIS HWY
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-4202
Practice Address - Country:US
Practice Address - Phone:704-786-1617
Practice Address - Fax:704-782-5114
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-02
Last Update Date:2007-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0980NC152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist