Basic Information
| Provider Information | |||||||||
| NPI: | 1992867402 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SNIPES | ||||||||
| FirstName: | RYAN | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | OD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 W ACADEMY ST | ||||||||
| Address2: | |||||||||
| City: | RANDLEMAN | ||||||||
| State: | NC | ||||||||
| PostalCode: | 273171504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3363371298 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 200 W ACADEMY ST | ||||||||
| Address2: | |||||||||
| City: | RANDLEMAN | ||||||||
| State: | NC | ||||||||
| PostalCode: | 273171504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3363371298 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/14/2006 | ||||||||
| LastUpdateDate: | 02/24/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/24/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 1839 | NC | Y | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | FH7000055 | 01 | NC | FIRST HEALTH | OTHER | 410034018 | 01 | NC | RRMC | OTHER | 0853510001 | 01 | NC | CIGNA GOVERNMENT SERVICES MEDICARE PART B DME | OTHER | 093HW | 01 | NC | BLUE CROSS BLUE SHIELD | OTHER | 30624 | 01 | NC | OPTICARE | OTHER | 89093HW | 05 | NC | MEDICAID | B5322 | 01 | NC | MEDCOST | OTHER |