Provider Demographics
NPI:1679699680
Name:SNOWDEN, TRACY (OD)
Entity type:Individual
Prefix:DR
First Name:TRACY
Middle Name:
Last Name:SNOWDEN
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 1:44 PEACHTREE PL NE UNIT 731
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-5402
Mailing Address - Country:US
Mailing Address - Phone:404-477-1166
Mailing Address - Fax:
Practice Address - Street 1:231 18TH ST NW STE 9130
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30363-1115
Practice Address - Country:US
Practice Address - Phone:404-685-9772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2351152W00000X
AZOPT-002653152W00000X
MDDA1386152W00000X
DCOP2000559152W00000X
MAOPT3798152W00000X
FLTPOP193152W00000X
GA1590152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist