Provider Demographics
NPI:1275853541
Name:FOREMAN, WILLIAM D (LO)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:D
Last Name:FOREMAN
Suffix:
Gender:M
Credentials:LO
Other - Prefix:
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Mailing Address - Street 1:131 BOSTON POST RD
Mailing Address - Street 2:SUITE4
Mailing Address - City:WATERFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06385-2839
Mailing Address - Country:US
Mailing Address - Phone:860-442-1167
Mailing Address - Fax:860-443-4118
Practice Address - Street 1:131 BOSTON POST RD
Practice Address - Street 2:SUITE 4
Practice Address - City:WATERFORD
Practice Address - State:CT
Practice Address - Zip Code:06385-2839
Practice Address - Country:US
Practice Address - Phone:860-442-1167
Practice Address - Fax:860-443-4118
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-09
Last Update Date:2010-06-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT000679156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1063571214Medicaid