Provider Demographics
NPI:1306902432
Name:SNOEYINK, THOMAS DALE (OD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:DALE
Last Name:SNOEYINK
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 1:3164 PORT SHELDON ST
Mailing Address - Street 2:
Mailing Address - City:HUDSONVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49426-9317
Mailing Address - Country:US
Mailing Address - Phone:616-669-1890
Mailing Address - Fax:616-669-8457
Practice Address - Street 1:3164 PORT SHELDON ST
Practice Address - Street 2:
Practice Address - City:HUDSONVILLE
Practice Address - State:MI
Practice Address - Zip Code:49426-9317
Practice Address - Country:US
Practice Address - Phone:616-669-1890
Practice Address - Fax:616-669-8457
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-01
Last Update Date:2015-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901002873152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0373700001OtherPTAN
MI0G06533Medicare PIN
MI0373700001OtherPTAN