Provider Demographics
NPI:1255312195
Name:MARSTON-FOUCHER, CAROL LYNN (OD)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:LYNN
Last Name:MARSTON-FOUCHER
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 1:32037 PLYMOUTH RD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48150-1908
Mailing Address - Country:US
Mailing Address - Phone:734-421-5454
Mailing Address - Fax:734-421-6133
Practice Address - Street 1:32037 PLYMOUTH RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48150-1908
Practice Address - Country:US
Practice Address - Phone:734-421-5454
Practice Address - Fax:734-421-6133
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901002789152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIT33867Medicare UPIN
MI410024473Medicare PIN
MI0377570001Medicare NSC