MEDICARE: CLAUD R SNOWDEN OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	046006647	IL
2	332B00000X	Durable Medical Equipment & Medical Supplies	046006647	IL

General Provider Information

NPI Number	:	1235122466
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLAUD R SNOWDEN OD

Provider Business Mailing Address
First Line	:	242 E FERGUSON AVE
Second Line	:
City	:	WOOD RIVER
State	:	IL
Zip	:	62095-2002
Country	:	US
Telephone Number	:	618-254-8463
Fax Number	:	618-254-4164

Provider Business Practice Location Address
First Line	:	242 E FERGUSON AVE
Second Line	:
City	:	WOOD RIVER
State	:	IL
Zip	:	62095-2002
Country	:	US
Telephone Number	:	618-254-8463
Fax Number	:	618-254-4164

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/23/2005
Last Update Date	:	06/24/2008

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Directions to “ CLAUD R SNOWDEN OD” Practice Location

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