Provider Demographics
NPI:1952394777
Name:SNEAG, GARY (OD,FCOVD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:
Last Name:SNEAG
Suffix:
Gender:M
Credentials:OD,FCOVD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4310 GENESEE AVE
Mailing Address - Street 2:STE 101
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92117-4970
Mailing Address - Country:US
Mailing Address - Phone:858-560-5181
Mailing Address - Fax:858-560-1926
Practice Address - Street 1:4310 GENESEE AVE
Practice Address - Street 2:STE 101
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92117-4970
Practice Address - Country:US
Practice Address - Phone:858-560-5181
Practice Address - Fax:858-560-1926
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-26
Last Update Date:2008-03-24
Deactivation Date:2006-03-27
Deactivation Code:
Reactivation Date:2006-04-10
Provider Licenses
StateLicense IDTaxonomies
CACA8399T152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWOP8399AMedicare PIN
U44125Medicare UPIN