Healthcare Provider Details

I. General information

NPI: 1518374123
Provider Name (Legal Business Name): BENJAMIN DEAN SNYDER O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2014
Last Update Date: 08/20/2024
Certification Date: 08/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 COCHRANE CIR # B7500
FORT CARSON CO
80913-4604
US

IV. Provider business mailing address

1650 COCHRANE CIR # B7500
FORT CARSON CO
80913-4604
US

V. Phone/Fax

Practice location:
  • Phone: 719-526-7000
  • Fax:
Mailing address:
  • Phone: 719-526-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT.0003075
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: