Healthcare Provider Details

I. General information

NPI: 1508056102
Provider Name (Legal Business Name): GARY SNEAG OD OPTOMETRIC CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2007
Last Update Date: 11/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4310 GENESEE AVE STE 101
SAN DIEGO CA
92117-4970
US

IV. Provider business mailing address

4310 GENESEE AVE STE 101
SAN DIEGO CA
92117-4970
US

V. Phone/Fax

Practice location:
  • Phone: 858-560-5181
  • Fax: 858-560-1926
Mailing address:
  • Phone: 858-560-5181
  • Fax: 858-560-1926

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License NumberOPT 8399
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT 8399
License Number StateCA

VIII. Authorized Official

Name: DR. GARY SNEAG
Title or Position: OWNER
Credential: D.O.
Phone: 858-560-5181