Provider Demographics
NPI:1194812735
Name:FOSTER FAMILY EYECARE
Entity type:Organization
Organization Name:FOSTER FAMILY EYECARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:MACY
Authorized Official - Middle Name:H
Authorized Official - Last Name:FOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:423-884-2500
Mailing Address - Street 1:1543 HIGHWAY 411
Mailing Address - Street 2:P.O. BOX 248
Mailing Address - City:VONORE
Mailing Address - State:TN
Mailing Address - Zip Code:37885-2449
Mailing Address - Country:US
Mailing Address - Phone:423-884-2500
Mailing Address - Fax:423-884-6015
Practice Address - Street 1:1543 HIGHWAY 411
Practice Address - Street 2:
Practice Address - City:VONORE
Practice Address - State:TN
Practice Address - Zip Code:37885-2449
Practice Address - Country:US
Practice Address - Phone:423-884-2500
Practice Address - Fax:423-884-6015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2010-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3943859Medicaid
TN3943859Medicaid
TN0706340004Medicare NSC
TNCH2937Medicare PIN