Healthcare Provider Details

I. General information

NPI: 1588728216
Provider Name (Legal Business Name): DAVID COOPER SNOWDON JR. O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 03/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109-6 MASONIC HOME RD CHARLTON OPTICAL
CHARLTON MA
01507-0194
US

IV. Provider business mailing address

17 ORCHARD RD
SHREWSBURY MA
01545-2717
US

V. Phone/Fax

Practice location:
  • Phone: 508-248-1188
  • Fax: 508-248-5128
Mailing address:
  • Phone: 508-736-6550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2825
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: