Healthcare Provider Details

I. General information

NPI: 1194812735
Provider Name (Legal Business Name): FOSTER FAMILY EYECARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 05/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1543 HIGHWAY 411
VONORE TN
37885-2449
US

IV. Provider business mailing address

1543 HIGHWAY 411 P.O. BOX 248
VONORE TN
37885-2449
US

V. Phone/Fax

Practice location:
  • Phone: 423-884-2500
  • Fax: 423-884-6015
Mailing address:
  • Phone: 423-884-2500
  • Fax: 423-884-6015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number StateTN

VIII. Authorized Official

Name: MACY H FOSTER
Title or Position: OPTOMETRIST
Credential: O.D.
Phone: 423-884-2500