Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician |
NPI | 1023677143 |
---|---|
Provider Name | Ronald Brad Foster |
First Address | Auburn, AL 36830-2811 |
Second Address | Auburn, AL 36830-2811 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2019 |
Last Update Date | 12/06/2019 |