Organization
PROFESSIONAL VISION INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RONALD L SNYDER OD (OWNER-PRESIDENT)
(574) 234-7600
Entity
Organization
Contact information
Practice address
17615 STATE ROAD 23, SOUTH BEND, IN 46635-1718
(574) 234-7600
(574) 234-8408
Mailing address
17615 STATE ROAD 23, SOUTH BEND, IN 46635-1718
(574) 234-7600
(574) 234-8408
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
18001393
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000105030
ANTHEM
IN
Enumeration date
09/28/2006
Last updated
08/22/2020
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