Provider Demographics
NPI:1215023080
Name:SNOWBERGER, SCOTT LEE (OD)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:LEE
Last Name:SNOWBERGER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:2051 GATTIS SCHOOL RD
Mailing Address - Street 2:SUITE 160
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78664
Mailing Address - Country:US
Mailing Address - Phone:512-388-2444
Mailing Address - Fax:512-388-0043
Practice Address - Street 1:2051 GATTIS SCHOOL RD
Practice Address - Street 2:SUITE 160
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78664
Practice Address - Country:US
Practice Address - Phone:512-388-2444
Practice Address - Fax:512-388-0043
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX6417T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX81143QOtherBLUE CROSS / BLUE SHIELD
U98467Medicare UPIN