Provider Demographics
NPI:1235122466
Name:SNOWDEN, CLAUD R (OD)
Entity Type:Individual
Prefix:
First Name:CLAUD
Middle Name:R
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 1:242 E FERGUSON AVE
Mailing Address - Street 2:
Mailing Address - City:WOOD RIVER
Mailing Address - State:IL
Mailing Address - Zip Code:62095-2002
Mailing Address - Country:US
Mailing Address - Phone:618-254-8463
Mailing Address - Fax:618-254-4164
Practice Address - Street 1:242 E FERGUSON AVE
Practice Address - Street 2:
Practice Address - City:WOOD RIVER
Practice Address - State:IL
Practice Address - Zip Code:62095-2002
Practice Address - Country:US
Practice Address - Phone:618-254-8463
Practice Address - Fax:618-254-4164
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-23
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046006647152W00000X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL410039060Medicare PIN
IL0301410001Medicare NSC
IL227980Medicare PIN
ILT35431Medicare UPIN