Provider Demographics
NPI:1720126139
Name:FOSTER, WALTER REED (OD)
Entity type:Individual
Prefix:DR
First Name:WALTER
Middle Name:REED
Last Name:FOSTER
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 1:11069 DOXBERRY CIR
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:MD
Mailing Address - Zip Code:21163-1479
Mailing Address - Country:US
Mailing Address - Phone:301-335-3945
Mailing Address - Fax:
Practice Address - Street 1:11069 DOXBERRY CIR
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:MD
Practice Address - Zip Code:21163-1479
Practice Address - Country:US
Practice Address - Phone:301-335-3945
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2014-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA0789152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist