Healthcare Provider Details

I. General information

NPI: 1740256890
Provider Name (Legal Business Name): MARK EDWARD SNYDER OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 01/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 SEA STREET EXT
HYANNIS MA
02601-5109
US

IV. Provider business mailing address

65 SEA STREET EXT
HYANNIS MA
02601-5109
US

V. Phone/Fax

Practice location:
  • Phone: 508-775-0881
  • Fax: 508-790-4311
Mailing address:
  • Phone: 508-775-0881
  • Fax: 508-790-4311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3374
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: