Healthcare Provider Details

I. General information

NPI: 1770694093
Provider Name (Legal Business Name): STEVEN G SNAPP OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 EAST CROY
HAILEY ID
83333-8407
US

IV. Provider business mailing address

14 EAST CROY
HAILEY ID
83333-8407
US

V. Phone/Fax

Practice location:
  • Phone: 208-788-4120
  • Fax: 208-788-3571
Mailing address:
  • Phone: 208-788-4120
  • Fax: 208-788-3571

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberODP0693
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: