Provider Demographics
NPI:1740258441
Name:SNYDER, RONALD LEE (OD)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:LEE
Last Name:SNYDER
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 1:17615 STATE RD 23
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46635
Mailing Address - Country:US
Mailing Address - Phone:574-234-7600
Mailing Address - Fax:574-234-8408
Practice Address - Street 1:17615 STATE RD 23
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46635
Practice Address - Country:US
Practice Address - Phone:574-234-7600
Practice Address - Fax:574-234-8408
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18001393152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200411330Medicaid
IN000000092862OtherANTHEM
IN198990AMedicare ID - Type Unspecified
IN000000092862OtherANTHEM
INU29800Medicare UPIN
IN200411330Medicaid
IN160450004Medicare PIN
IN452570025Medicare PIN