Provider Demographics
NPI:1629163928
Name:FOSTER, PAIGE BUSH (OD)
Entity Type:Individual
Prefix:DR
First Name:PAIGE
Middle Name:BUSH
Last Name:FOSTER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1013 EAST FREEWAY DRIVE
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30094
Mailing Address - Country:US
Mailing Address - Phone:770-922-7906
Mailing Address - Fax:770-483-0498
Practice Address - Street 1:1013 EAST FREEWAY DRIVE
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30094
Practice Address - Country:US
Practice Address - Phone:770-922-7906
Practice Address - Fax:770-483-0498
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA001656152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA0007600451OtherAETNA PPO
GAGA0796OtherEYEMED
GAP00033636OtherRAILROAD MEDICARE
GA3179543OtherAETNA HMO
GAP00033636OtherAETNA PPO
GA33529OtherAVESIS
GA727817OtherBCBSGA
GAP00033636OtherRAILROAD MEDICARE
GAU72463Medicare UPIN