=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386881035
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RICHARD L FOSTER CPO
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/16/2009
-----------------------------------------------------
Last Update Date | 06/17/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 125 E 3RD ST STE C
-----------------------------------------------------
City | EDMOND
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73034-3822
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-285-5499
-----------------------------------------------------
Fax | 405-285-5448
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 125 E 3RD ST STE C
-----------------------------------------------------
City | EDMOND
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73034-3822
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-285-5499
-----------------------------------------------------
Fax | 405-285-5448
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 224P00000X
-----------------------------------------------------
Taxonomy Name | Prosthetist
-----------------------------------------------------
License Number | LP39
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 222Z00000X
-----------------------------------------------------
Taxonomy Name | Orthotist
-----------------------------------------------------
License Number | LO41
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------