Provider Demographics
NPI:1588728216
Name:SNOWDON, DAVID COOPER JR (OD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:COOPER
Last Name:SNOWDON
Suffix:JR
Gender:M
Credentials:OD
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Mailing Address - Street 1:17 ORCHARD RD
Mailing Address - Street 2:
Mailing Address - City:SHREWSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01545-2717
Mailing Address - Country:US
Mailing Address - Phone:508-736-6550
Mailing Address - Fax:
Practice Address - Street 1:109-6 MASONIC HOME RD
Practice Address - Street 2:CHARLTON OPTICAL
Practice Address - City:CHARLTON
Practice Address - State:MA
Practice Address - Zip Code:01507-0194
Practice Address - Country:US
Practice Address - Phone:508-248-1188
Practice Address - Fax:508-248-5128
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2011-03-11
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Provider Licenses
StateLicense IDTaxonomies
MA2825152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA184958Medicare ID - Type Unspecified