Provider Demographics
NPI:1558335224
Name:FOSS, RICHARD LEE (OD)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:LEE
Last Name:FOSS
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 1:3424 MORMON COULEE RD
Mailing Address - Street 2:STE A
Mailing Address - City:LACROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54601-6750
Mailing Address - Country:US
Mailing Address - Phone:608-788-4300
Mailing Address - Fax:608-788-4325
Practice Address - Street 1:3424 MORMON COULEE RD
Practice Address - Street 2:STE A
Practice Address - City:LACROSSE
Practice Address - State:WI
Practice Address - Zip Code:54601-6750
Practice Address - Country:US
Practice Address - Phone:608-788-4300
Practice Address - Fax:608-788-4325
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-17
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1466152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38563100Medicaid
T61932Medicare UPIN
WI000047470Medicare PIN