Provider Demographics
NPI:1811949530
Name:SNYDER, MARK A (OD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:A
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 1:1035 N POST RD STE B
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4245
Mailing Address - Country:US
Mailing Address - Phone:317-449-2122
Mailing Address - Fax:317-449-2123
Practice Address - Street 1:1035 N POST RD STE B
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46219-4245
Practice Address - Country:US
Practice Address - Phone:317-449-2122
Practice Address - Fax:317-449-2123
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2018-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003340A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300009910Medicaid
INP00339418OtherMEDICARE ID
IN200844880Medicaid
INV01542Medicare UPIN