Provider Demographics
NPI:1780711911
Name:EYE SOURCE LLC
Entity type:Organization
Organization Name:EYE SOURCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:SNYDER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:561-347-7977
Mailing Address - Street 1:21126 SAINT ANDREWS BLVD
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-2404
Mailing Address - Country:US
Mailing Address - Phone:561-347-7977
Mailing Address - Fax:561-347-7311
Practice Address - Street 1:21126 SAINT ANDREWS BLVD
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-2404
Practice Address - Country:US
Practice Address - Phone:561-347-7977
Practice Address - Fax:561-347-7311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2013-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty