Provider Demographics
NPI:1205035110
Name:DR. SNOWDEN M BOOTH
Entity Type:Organization
Organization Name:DR. SNOWDEN M BOOTH
Other - Org Name:BURIEN EYECARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SNOWDEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:BOOTH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:206-242-8545
Mailing Address - Street 1:625 SW 153RD ST
Mailing Address - Street 2:
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98166-2216
Mailing Address - Country:US
Mailing Address - Phone:206-242-8545
Mailing Address - Fax:206-244-2020
Practice Address - Street 1:625 SW 153RD ST
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-2216
Practice Address - Country:US
Practice Address - Phone:206-242-8545
Practice Address - Fax:206-244-2020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-12
Last Update Date:2009-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOL796152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA000100550OtherMEDICARE ID-TYPE UNSPECIFIED
WA2082600Medicaid
T01532Medicare UPIN
WA2082600Medicaid
0665680001Medicare NSC