Healthcare Provider Details

I. General information

NPI: 1063502730
Provider Name (Legal Business Name): PAUL ALAN SNYDER O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 12/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2125 E THOUSAND OAKS BLVD SUITE A
THOUSAND OAKS CA
91362-2942
US

IV. Provider business mailing address

2125 E THOUSAND OAKS BLVD SUITE A
THOUSAND OAKS CA
91362-2942
US

V. Phone/Fax

Practice location:
  • Phone: 805-497-7373
  • Fax:
Mailing address:
  • Phone: 805-497-7373
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number12005
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: