Provider Demographics
NPI:1770694093
Name:SNAPP, STEVEN G (OD)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:G
Last Name:SNAPP
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 1:14 EAST CROY
Mailing Address - Street 2:
Mailing Address - City:HAILEY
Mailing Address - State:ID
Mailing Address - Zip Code:83333-8407
Mailing Address - Country:US
Mailing Address - Phone:208-788-4120
Mailing Address - Fax:208-788-3571
Practice Address - Street 1:14 EAST CROY
Practice Address - Street 2:
Practice Address - City:HAILEY
Practice Address - State:ID
Practice Address - Zip Code:83333-8407
Practice Address - Country:US
Practice Address - Phone:208-788-4120
Practice Address - Fax:208-788-3571
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDODP0693152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID002458200Medicaid
410004003Medicare ID - Type UnspecifiedRAILROAD
T44349Medicare UPIN
ID002458200Medicaid