MEDICARE: DR. THOMAS DALE SNOEYINK OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	4901002873	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0373700001	OTHER	MI	PTAN

General Provider Information

NPI Number	:	1306902432
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS DALE SNOEYINK OD

Provider Business Mailing Address
First Line	:	3164 PORT SHELDON ST
Second Line	:
City	:	HUDSONVILLE
State	:	MI
Zip	:	49426-9317
Country	:	US
Telephone Number	:	616-669-1890
Fax Number	:	616-669-8457

Provider Business Practice Location Address
First Line	:	3164 PORT SHELDON ST
Second Line	:
City	:	HUDSONVILLE
State	:	MI
Zip	:	49426-9317
Country	:	US
Telephone Number	:	616-669-1890
Fax Number	:	616-669-8457

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/01/2007
Last Update Date	:	12/11/2015

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