Healthcare Provider Details

I. General information

NPI: 1033360094
Provider Name (Legal Business Name): MATTHEW C SNIEGOWSKI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2008
Last Update Date: 07/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11261 NALL AVE
LEAWOOD KS
66211-1669
US

IV. Provider business mailing address

11261 NALL AVE
LEAWOOD KS
66211-1669
US

V. Phone/Fax

Practice location:
  • Phone: 913-261-2020
  • Fax: 916-261-2090
Mailing address:
  • Phone: 913-261-2020
  • Fax: 916-261-2090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number2015009832
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number0437902
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: