Healthcare Provider Details

I. General information

NPI: 1952394777
Provider Name (Legal Business Name): GARY SNEAG O.D.,F.C.O.V.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2005
Last Update Date: 03/24/2008
Certification Date:
Deactivation Date: 03/27/2006
Reactivation Date: 04/10/2006

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 TaxonomyY
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License NumberCA8399T
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: