Provider Demographics
NPI:1053322107
Name:FOSTER, MACY H (OD)
Entity Type:Individual
Prefix:DR
First Name:MACY
Middle Name:H
Last Name:FOSTER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:689A HWY 68
Mailing Address - Street 2:
Mailing Address - City:SWEETWATER
Mailing Address - State:TN
Mailing Address - Zip Code:37874
Mailing Address - Country:US
Mailing Address - Phone:423-337-9222
Mailing Address - Fax:423-337-9099
Practice Address - Street 1:689A NEW HIGHWAY 68
Practice Address - Street 2:
Practice Address - City:SWEETWATER
Practice Address - State:TN
Practice Address - Zip Code:37874-1911
Practice Address - Country:US
Practice Address - Phone:423-337-9222
Practice Address - Fax:423-337-9099
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1420152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0167823OtherBCBS
TN410021701Medicare PIN
TN0167823OtherBCBS
TN3598708Medicare PIN
TN0167823OtherBCBS
TN410043680Medicare PIN
TN3598709Medicare PIN