Provider Demographics
NPI:1386881035
Name:FOSTER, RICHARD L (CPO)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:L
Last Name:FOSTER
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 E 3RD ST STE C
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-3822
Mailing Address - Country:US
Mailing Address - Phone:405-285-5499
Mailing Address - Fax:405-285-5448
Practice Address - Street 1:125 E 3RD ST STE C
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-3822
Practice Address - Country:US
Practice Address - Phone:405-285-5499
Practice Address - Fax:405-285-5448
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-16
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKLP39224P00000X
OKLO41222Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200625420AMedicaid