Provider Demographics
NPI:1346326071
Name:FOOTE, HOWARD (OD)
Entity Type:Individual
Prefix:
First Name:HOWARD
Middle Name:
Last Name:FOOTE
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 1:9125 BURNING TREE DR
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-9528
Mailing Address - Country:US
Mailing Address - Phone:810-694-2020
Mailing Address - Fax:
Practice Address - Street 1:1379 FLUSHING RD
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:MI
Practice Address - Zip Code:48433-2262
Practice Address - Country:US
Practice Address - Phone:810-659-3135
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2009-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901002303152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI900B514120OtherBLUE CARE NETWORK
MI945089340Medicaid
MI900B565541OtherBCBSM
MI945089340Medicaid
MI0N21210002Medicare ID - Type UnspecifiedWPS MEDICARE