Provider Demographics
NPI:1154343911
Name:SNYDER, GARY V (OD)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:V
Last Name:SNYDER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1002 LEXINGTON RD
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40324-1463
Mailing Address - Country:US
Mailing Address - Phone:502-868-0422
Mailing Address - Fax:502-867-1967
Practice Address - Street 1:1002 LEXINGTON RD
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:KY
Practice Address - Zip Code:40324-1463
Practice Address - Country:US
Practice Address - Phone:502-868-0422
Practice Address - Fax:502-867-1967
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0988DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY37903705OtherMEDICAID LAB GROUP
KYCN0474OtherRR MEDICARE GROUP
KY77902674OtherMEDICAID GROUP NUMBER
KY410018421OtherRR MEDICARE PIN
KY4000501OtherMEDICARE LAB GROUP
KY77009884Medicaid
KY410018421OtherRR MEDICARE PIN
KYCN0474OtherRR MEDICARE GROUP
KY77902674OtherMEDICAID GROUP NUMBER