Provider Demographics
NPI:1437857034
Name:FOSTER FAMILY HOLDINGS
Entity Type:Organization
Organization Name:FOSTER FAMILY HOLDINGS
Other - Org Name:WESTSIDE OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NAQUETTA
Authorized Official - Middle Name:
Authorized Official - Last Name:FOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:ABOC
Authorized Official - Phone:616-458-7978
Mailing Address - Street 1:833 LEONARD ST NW STE B
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49504-4163
Mailing Address - Country:US
Mailing Address - Phone:616-458-7978
Mailing Address - Fax:616-458-3719
Practice Address - Street 1:833 LEONARD ST NW STE B
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49504-4163
Practice Address - Country:US
Practice Address - Phone:616-458-7978
Practice Address - Fax:616-458-3719
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-22
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty