Healthcare Provider Details

I. General information

NPI: 1881929222
Provider Name (Legal Business Name): BRIAN EDWARD SNYDSMAN O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2009
Last Update Date: 08/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3201 MISSION ST
SAN FRANCISCO CA
94110-5006
US

IV. Provider business mailing address

3201 MISSION ST
SAN FRANCISCO CA
94110-5006
US

V. Phone/Fax

Practice location:
  • Phone: 415-648-3600
  • Fax:
Mailing address:
  • Phone: 415-648-3600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOD60098932
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT13858
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: