Provider Demographics
NPI:1982931689
Name:DR. TRACY SNOWDEN O.D., P.C.
Entity type:Organization
Organization Name:DR. TRACY SNOWDEN O.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:SNOWDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-593-6750
Mailing Address - Street 1:44 PEACHTREE PLACE
Mailing Address - Street 2:731
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-5402
Mailing Address - Country:US
Mailing Address - Phone:404-593-6750
Mailing Address - Fax:404-963-0079
Practice Address - Street 1:1940 MOUNTAIN INDUSTRIAL BLVD
Practice Address - Street 2:
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-6619
Practice Address - Country:US
Practice Address - Phone:678-280-0248
Practice Address - Fax:678-280-0251
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-17
Last Update Date:2009-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT001590152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty