Healthcare Provider Details

I. General information

NPI: 1386881035
Provider Name (Legal Business Name): RICHARD L FOSTER CPO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2009
Last Update Date: 06/17/2021
Certification Date: 06/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 E 3RD ST STE C
EDMOND OK
73034-3822
US

IV. Provider business mailing address

125 E 3RD ST STE C
EDMOND OK
73034-3822
US

V. Phone/Fax

Practice location:
  • Phone: 405-285-5499
  • Fax: 405-285-5448
Mailing address:
  • Phone: 405-285-5499
  • Fax: 405-285-5448

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License NumberLP39
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code222Z00000X
TaxonomyOrthotist
License NumberLO41
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: