Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 4901004190 | MI |
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 4901004190 | MI |
N | 152WL0500X | Optomitrist - Low Vision Rehabilitation | 4901004190 | MI |
N | 152WP0200X | Pediatric Optomitrist | 4901004190 | MI |
N | 152WV0400X | Optomitrist - Vision Therapist | 4901004190 | MI |
N | 152WX0102X | Occupational Vision | 4901004190 | MI |
NPI | 1346233681 |
---|---|
Provider Name | Carlton J Foster |
First Address | Ann Arbor, MI 48108 |
Second Address | Ann Arbor, MI 48105-1912 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2005 |
Last Update Date | 09/03/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4570397 | (05) | MI |
4644703 | (05) | MI |
CF004190 | BCBS MICHIGAN (01) | MI |
U87606 | (02) | MI |