Healthcare Provider Details

I. General information

NPI: 1437857034
Provider Name (Legal Business Name): FOSTER FAMILY HOLDINGS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2023
Last Update Date: 04/22/2024
Certification Date: 04/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

833 LEONARD ST NW STE B
GRAND RAPIDS MI
49504-4163
US

IV. Provider business mailing address

833 LEONARD ST NW STE B
GRAND RAPIDS MI
49504-4163
US

V. Phone/Fax

Practice location:
  • Phone: 616-458-7978
  • Fax: 616-458-3719
Mailing address:
  • Phone: 616-458-7978
  • Fax: 616-458-3719

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State

VIII. Authorized Official

Name: NAQUETTA FOSTER
Title or Position: OWNER
Credential: ABOC
Phone: 616-458-7978