Provider Demographics
NPI:1669464442
Name:FOSTER, JOHN PHILIP (OD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:PHILIP
Last Name:FOSTER
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 1:2325 ABERDEEN BLVD
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-0614
Mailing Address - Country:US
Mailing Address - Phone:704-853-3937
Mailing Address - Fax:704-853-0840
Practice Address - Street 1:2325 ABERDEEN BLVD
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-0614
Practice Address - Country:US
Practice Address - Phone:704-853-3937
Practice Address - Fax:704-853-0840
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1792152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC093G7OtherBLUE CROSS OF NC
NC89093G7Medicaid
NCC7619OtherMEDCOST
NC803959OtherPARTNERS MEDICARE CHOICE
NC1577Medicare PIN
NC803959OtherPARTNERS MEDICARE CHOICE
NC89093G7Medicaid