Healthcare Provider Details

I. General information

NPI: 1346242955
Provider Name (Legal Business Name): DUANE SNYDER OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2005
Last Update Date: 04/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 DAVISON RD
LOCKPORT NY
14094-4021
US

IV. Provider business mailing address

500 DAVISON RD
LOCKPORT NY
14094-4021
US

V. Phone/Fax

Practice location:
  • Phone: 716-434-8063
  • Fax: 716-434-2845
Mailing address:
  • Phone: 716-434-8063
  • Fax: 716-434-2845

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTUV004475-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOE-006323-P
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: