Provider Demographics
NPI:1417520644
Name:SNYDER, MICHAELE DORIES (OD)
Entity type:Individual
Prefix:DR
First Name:MICHAELE
Middle Name:DORIES
Last Name:SNYDER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:13904 N DALE MABRY HWY STE 200
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33618-2446
Mailing Address - Country:US
Mailing Address - Phone:813-908-2020
Mailing Address - Fax:813-908-2133
Practice Address - Street 1:13904 N DALE MABRY HWY STE 200
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-2446
Practice Address - Country:US
Practice Address - Phone:813-908-2020
Practice Address - Fax:813-908-2133
Is Sole Proprietor?:No
Enumeration Date:2021-07-24
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT003345152W00000X
FLOPC6421152W00000X
ALR-323-TA-C68152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist