Provider Demographics
NPI:1275669301
Name:FOERSTER, GLENN ANDREW (OPTICIAN)
Entity Type:Individual
Prefix:MR
First Name:GLENN
Middle Name:ANDREW
Last Name:FOERSTER
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2327 NEW RD
Mailing Address - Street 2:SUITE # 103
Mailing Address - City:NORTHFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:08225-1433
Mailing Address - Country:US
Mailing Address - Phone:609-641-5747
Mailing Address - Fax:609-641-3990
Practice Address - Street 1:2327 NEW RD
Practice Address - Street 2:SUITE # 103
Practice Address - City:NORTHFIELD
Practice Address - State:NJ
Practice Address - Zip Code:08225-1433
Practice Address - Country:US
Practice Address - Phone:609-641-5747
Practice Address - Fax:609-641-3990
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ31TD00146500156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0387510001Medicare ID - Type UnspecifiedPROVIDER #