Healthcare Provider Details

I. General information

NPI: 1154477230
Provider Name (Legal Business Name): DELBERT WAYNE FOUST
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1416 S MAIN SUITE 380
ADRIAN MI
49221-4302
US

IV. Provider business mailing address

140 MACOMB
MT CLEMENS MI
48043
US

V. Phone/Fax

Practice location:
  • Phone: 517-265-8086
  • Fax: 517-263-5253
Mailing address:
  • Phone: 586-468-7370
  • Fax: 586-464-1472

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4901002905
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: