Provider Demographics
NPI:1447942800
Name:POVEDA, SNEHIDER
Entity type:Individual
Prefix:
First Name:SNEHIDER
Middle Name:
Last Name:POVEDA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6830 NORMANDY BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32205-1902
Mailing Address - Country:US
Mailing Address - Phone:904-786-2234
Mailing Address - Fax:904-786-2242
Practice Address - Street 1:6830 NORMANDY BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32205-1902
Practice Address - Country:US
Practice Address - Phone:904-786-2234
Practice Address - Fax:904-786-2242
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-24
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDO6917156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician