Healthcare Provider Details

I. General information

NPI: 1346326071
Provider Name (Legal Business Name): HOWARD FOOTE O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 05/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1379 FLUSHING RD
FLUSHING MI
48433-2262
US

IV. Provider business mailing address

9125 BURNING TREE DR
GRAND BLANC MI
48439-9528
US

V. Phone/Fax

Practice location:
  • Phone: 810-659-3135
  • Fax:
Mailing address:
  • Phone: 810-694-2020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4901002303
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: