Provider Demographics
NPI:1932772100
Name:DR SNYDER OD LLC
Entity Type:Organization
Organization Name:DR SNYDER OD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:SNYDER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:317-219-9743
Mailing Address - Street 1:12925 WATER RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46055-9650
Mailing Address - Country:US
Mailing Address - Phone:317-219-9743
Mailing Address - Fax:
Practice Address - Street 1:6020 E 82ND ST
Practice Address - Street 2:MACY'S
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250
Practice Address - Country:US
Practice Address - Phone:317-845-9168
Practice Address - Fax:317-845-9177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-23
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300009910Medicaid