Provider Demographics
NPI:1023206166
Name:DANIEL S FOREMAN MD
Entity Type:Organization
Organization Name:DANIEL S FOREMAN MD
Other - Org Name:DANIEL S FOREMAN MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:FOREMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:530-885-3767
Mailing Address - Street 1:3126 PROFESSIONAL DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95603-2407
Mailing Address - Country:US
Mailing Address - Phone:530-885-3767
Mailing Address - Fax:530-885-3201
Practice Address - Street 1:3126 PROFESSIONAL DR
Practice Address - Street 2:SUITE 300
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95603-2407
Practice Address - Country:US
Practice Address - Phone:530-885-3767
Practice Address - Fax:530-885-3201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-12
Last Update Date:2009-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT6581T152W00000X
CAA45204174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF11433Medicare UPIN
CA1309430001Medicare NSC
CAZZZ21772ZMedicare PIN