Healthcare Provider Details

I. General information

NPI: 1306860770
Provider Name (Legal Business Name): BRUCE EDMUND SNYDER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 12/08/2022
Certification Date: 12/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 W CHARLESTON BLVD
LAS VEGAS NV
89102-2329
US

IV. Provider business mailing address

2290 DRIFTWOOD TIDE AVE
HENDERSON NV
89052-5803
US

V. Phone/Fax

Practice location:
  • Phone: 702-453-3799
  • Fax: 702-453-5741
Mailing address:
  • Phone: 702-485-2020
  • Fax: 702-458-2050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number11814
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: