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General NPI Number Information
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NPI Number | 1184838609
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Entity Type | Organization
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Legal Business Name | SNODGRASS EYE CARE
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Dates
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Enumeration Date | 05/10/2007
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 60 N MILLER RD STE A
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City | FAIRLAWN
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State | OH
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Zip | 44333-3702
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Country | US
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Telephone | 330-836-2945
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Fax | 330-836-2955
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Provider Business Mailing Address
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Address Line | 60 N. MILLER RD. STE. A
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City | FAIRLAWN
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State | OH
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Zip | 44333
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Country | US
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Telephone | 330-836-2945
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Fax | 330-836-2955
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. KIM K. SNODGRASS
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Credential |
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Telephone | 330-836-2945
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332900000X
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Taxonomy Name | Non-Pharmacy Dispensing Site
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License Number | 2497A-SC
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License Number State | OH
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