Provider Demographics
NPI:1578666012
Name:FOSTER, CHARLES ARNOLD II (OD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:ARNOLD
Last Name:FOSTER
Suffix:II
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:PO BOX 146
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:TX
Mailing Address - Zip Code:75146
Mailing Address - Country:US
Mailing Address - Phone:972-223-2020
Mailing Address - Fax:972-228-1860
Practice Address - Street 1:1233 E PLEASANT RUN RD
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-4200
Practice Address - Country:US
Practice Address - Phone:972-223-2020
Practice Address - Fax:972-293-1860
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-07
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2491T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB105792Medicare PIN