Healthcare Provider Details

I. General information

NPI: 1578666012
Provider Name (Legal Business Name): CHARLES ARNOLD FOSTER II OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 05/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1233 E PLEASANT RUN RD
DESOTO TX
75115-4200
US

IV. Provider business mailing address

PO BOX 146
LANCASTER TX
75146
US

V. Phone/Fax

Practice location:
  • Phone: 972-223-2020
  • Fax: 972-293-1860
Mailing address:
  • Phone: 972-223-2020
  • Fax: 972-228-1860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2491T
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: