Provider Demographics
NPI:1558546499
Name:SCOTT FOSTER
Entity Type:Organization
Organization Name:SCOTT FOSTER
Other - Org Name:FAMILY VISION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:FOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:816-630-1905
Mailing Address - Street 1:1717 W JESSE JAMES RD
Mailing Address - Street 2:
Mailing Address - City:EXCELSIOR SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:64024-1801
Mailing Address - Country:US
Mailing Address - Phone:816-630-1905
Mailing Address - Fax:816-637-2034
Practice Address - Street 1:1717 W JESSE JAMES RD
Practice Address - Street 2:
Practice Address - City:EXCELSIOR SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64024-1801
Practice Address - Country:US
Practice Address - Phone:816-630-1905
Practice Address - Fax:816-637-2034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-09
Last Update Date:2012-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
13805013OtherBLUE CROSS BLUE SHIELD
0414410001Medicare NSC
13805013OtherBLUE CROSS BLUE SHIELD