Basic Information
| Provider Information | |||||||||
| NPI: | 1881981231 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SNYDER | ||||||||
| FirstName: | ELLIOTT | ||||||||
| MiddleName: | HAROLD | ||||||||
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| Credential: | O.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 275 W 28TH ST | ||||||||
| Address2: | |||||||||
| City: | YUMA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853647308 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9287821980 | ||||||||
| FaxNumber: | 9283452950 | ||||||||
| Practice Location | |||||||||
| Address1: | 275 W 28TH ST | ||||||||
| Address2: | |||||||||
| City: | YUMA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853647308 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9287821980 | ||||||||
| FaxNumber: | 9283452950 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/06/2011 | ||||||||
| LastUpdateDate: | 02/22/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 8027479-9934 | UT | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.