Provider Demographics
NPI:1659937274
Name:FOSTER, NATHANIEL ARTHUR
Entity Type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:ARTHUR
Last Name:FOSTER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:354 MEDICAL GROUP
Mailing Address - Street 2:2630 CENTRAL AVE
Mailing Address - City:EIELSON AFB
Mailing Address - State:AK
Mailing Address - Zip Code:99702-2301
Mailing Address - Country:US
Mailing Address - Phone:907-377-6682
Mailing Address - Fax:
Practice Address - Street 1:354 MEDICAL GROUP
Practice Address - Street 2:2630 CENTRAL AVENUE
Practice Address - City:EIELSON AFB
Practice Address - State:AK
Practice Address - Zip Code:99072-2301
Practice Address - Country:US
Practice Address - Phone:907-377-6684
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-20
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV008980152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist