Provider Demographics
NPI:1043294697
Name:FOSTER, GREGORY A (OD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:A
Last Name:FOSTER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:446 COURT ST
Mailing Address - Street 2:P.O. BOX 31
Mailing Address - City:NEILLSVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:54456-1955
Mailing Address - Country:US
Mailing Address - Phone:715-743-3126
Mailing Address - Fax:715-743-5050
Practice Address - Street 1:446 COURT ST
Practice Address - Street 2:
Practice Address - City:NEILLSVILLE
Practice Address - State:WI
Practice Address - Zip Code:54456-1955
Practice Address - Country:US
Practice Address - Phone:715-743-3126
Practice Address - Fax:715-743-5050
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2010-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1728-035152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38518300Medicaid
WI38518300Medicaid
T61935Medicare UPIN