Provider Demographics
NPI:1881981231
Name:SNYDER, ELLIOTT HAROLD (OD)
Entity type:Individual
Prefix:
First Name:ELLIOTT
Middle Name:HAROLD
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 1:275 W 28TH ST
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-7308
Mailing Address - Country:US
Mailing Address - Phone:928-782-1980
Mailing Address - Fax:928-345-2950
Practice Address - Street 1:275 W 28TH ST
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-7308
Practice Address - Country:US
Practice Address - Phone:928-782-1980
Practice Address - Fax:928-345-2950
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-06
Last Update Date:2013-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8027479-9934152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist