Provider Demographics
NPI:1457361826
Name:SNOW, MARSHA S (OD)
Entity Type:Individual
Prefix:
First Name:MARSHA
Middle Name:S
Last Name:SNOW
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1716 UNIVERSITY BLVD
Mailing Address - Street 2:HPB G080A
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35294-0001
Mailing Address - Country:US
Mailing Address - Phone:205-934-4748
Mailing Address - Fax:205-934-6755
Practice Address - Street 1:1716 UNIVERSITY BLVD
Practice Address - Street 2:HPB G080A
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35294-0001
Practice Address - Country:US
Practice Address - Phone:205-934-4748
Practice Address - Fax:205-934-6755
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2010-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS964TA527152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51503802OtherBCBS
AL051510420OtherBLUE CROSS
AL009958500Medicaid
ALU86013OtherVIVA
MS06470763Medicaid
AL009916335Medicaid
ALU86013OtherHEALTHSPRING
AL410049708Medicare PIN
AL051510420OtherBLUE CROSS
AL009958500Medicaid
AL051503802Medicare PIN
ALU86013OtherHEALTHSPRING