Provider Demographics
NPI:1154477230
Name:FOUST, DELBERT WAYNE
Entity Type:Individual
Prefix:
First Name:DELBERT
Middle Name:WAYNE
Last Name:FOUST
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 MACOMB
Mailing Address - Street 2:
Mailing Address - City:MT CLEMENS
Mailing Address - State:MI
Mailing Address - Zip Code:48043
Mailing Address - Country:US
Mailing Address - Phone:586-468-7370
Mailing Address - Fax:586-464-1472
Practice Address - Street 1:1416 S MAIN
Practice Address - Street 2:SUITE 380
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-4302
Practice Address - Country:US
Practice Address - Phone:517-265-8086
Practice Address - Fax:517-263-5253
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901002905152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U30022Medicare UPIN