Provider Demographics
NPI:1164476826
Name:FOON, IRVING IRA (OD)
Entity Type:Individual
Prefix:DR
First Name:IRVING
Middle Name:IRA
Last Name:FOON
Suffix:
Gender:M
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:G3541 MILLER RD
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-1235
Mailing Address - Country:US
Mailing Address - Phone:810-732-8610
Mailing Address - Fax:810-732-8631
Practice Address - Street 1:G3541 MILLER RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-1235
Practice Address - Country:US
Practice Address - Phone:810-732-8610
Practice Address - Fax:810-732-8631
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2010-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901002294152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI27671OtherSPECTERA
MI382218114OtherTAX ID
MI4901002294OtherLICENSE
MI7333067OtherAETNA
MI230370OtherNVA - HERITAGE
MI31986OtherCOLE
MI1004305OtherMCLAREN MEDICAID
MI945090459Medicaid
MI900B562000OtherBCBS
MI900B562000OtherHEALTHPLUS
MI900B562000OtherHEALTHPLUS
MI1004305OtherMCLAREN MEDICAID
MI27671OtherSPECTERA
MI4901002294OtherLICENSE