Provider Demographics
NPI:1164432878
Name:FOUST, PHILLIP E
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:E
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 1:1725 SE WASHINGTON BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:BARTLESVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74006-6724
Mailing Address - Country:US
Mailing Address - Phone:918-333-3636
Mailing Address - Fax:918-335-1725
Practice Address - Street 1:1725 SE WASHINGTON BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:BARTLESVILLE
Practice Address - State:OK
Practice Address - Zip Code:74006-6724
Practice Address - Country:US
Practice Address - Phone:918-333-3636
Practice Address - Fax:918-335-1725
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2018-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1132152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100763250AMedicaid
OK4437020272Medicare PIN
OKT40449Medicare UPIN