Provider Demographics
NPI:1235121872
Name:SNOWDEN, PAUL BRIAN (OD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:BRIAN
Last Name:SNOWDEN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7200 S PENN AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73159-3336
Mailing Address - Country:US
Mailing Address - Phone:405-682-8991
Mailing Address - Fax:405-682-8030
Practice Address - Street 1:7200 S PENN AVE
Practice Address - Street 2:SUITE D
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73159-3336
Practice Address - Country:US
Practice Address - Phone:405-682-8991
Practice Address - Fax:405-682-8030
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-19
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2472152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK267677Medicare PIN
OK5586940001Medicare NSC
OKP01183777Medicare PIN