Healthcare Provider Details

I. General information

NPI: 1376612309
Provider Name (Legal Business Name): BRIAN KEITH FOUTCH O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 01/12/2026
Certification Date: 01/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20231 W VALLEY BLVD STE G
TEHACHAPI CA
93561-6865
US

IV. Provider business mailing address

102 ELDERBERRY CT
TEHACHAPI CA
93561-8984
US

V. Phone/Fax

Practice location:
  • Phone: 661-822-1212
  • Fax:
Mailing address:
  • Phone: 210-445-3507
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number5978T
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT36143
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: