MEDICARE: FOSTER PRIMARY EYE CARE LTD

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	1728-035	WI

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

General Provider Information

NPI Number	:	1972741353
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOSTER PRIMARY EYE CARE LTD

Provider Business Mailing Address
First Line	:	2 E MAIN ST
Second Line	:	P.O. BOX 190
City	:	BLACK RIVER FALLS
State	:	WI
Zip	:	54615-1409
Country	:	US
Telephone Number	:	715-284-4876
Fax Number	:	715-284-4051

Provider Business Practice Location Address
First Line	:	2 E MAIN ST
Second Line	:
City	:	BLACK RIVER FALLS
State	:	WI
Zip	:	54615-1409
Country	:	US
Telephone Number	:	715-284-4876
Fax Number	:	715-284-4051

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. GREGORY ALAN FOSTER
Credential	:	O.D.
Telephone Number	:	715-284-4876

Provider Enumeration Date	:	01/23/2009
Last Update Date	:	11/18/2010

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Directions to “FOSTER PRIMARY EYE CARE LTD ” Practice Location

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