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1346233681

NPI Code Detail

MEDICARE: CARLTON J FOSTER O.D.

MEDICARE: CARLTON J FOSTER O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	4901004190	MI
2	152WC0802X	Corneal and Contact Management Optometrist	4901004190	MI
3	152WL0500X	Low Vision Rehabilitation Optometrist	4901004190	MI
4	152WP0200X	Pediatric Optometrist	4901004190	MI
5	152WV0400X	Vision Therapy Optometrist	4901004190	MI
6	152WX0102X	Occupational Vision Optometrist	4901004190	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	CF004190	OTHER	MI	BCBS MICHIGAN

General Provider Information

NPI Number	:	1346233681
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLTON J FOSTER O.D.

Provider Business Mailing Address
First Line	:	3621 S STATE ST
Second Line	:	700 KMS PLACE
City	:	ANN ARBOR
State	:	MI
Zip	:	48108
Country	:	US
Telephone Number	:	734-936-2047
Fax Number	:

Provider Business Practice Location Address
First Line	:	1000 WALL ST
Second Line	:
City	:	ANN ARBOR
State	:	MI
Zip	:	48105-1912
Country	:	US
Telephone Number	:	734-764-4190
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/23/2005
Last Update Date	:	03/09/2012

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Directions to “ CARLTON J FOSTER O.D.” Practice Location

Language	Start Address	Practice Location

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