Provider Demographics
NPI:1023719739
Name:FOSTER, NAQUETTA
Entity type:Individual
Prefix:
First Name:NAQUETTA
Middle Name:
Last Name:FOSTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:833 LEONARD ST NW STE B
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49504-4163
Mailing Address - Country:US
Mailing Address - Phone:616-458-7978
Mailing Address - Fax:616-458-3719
Practice Address - Street 1:833 LEONARD ST NW STE B
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49504-4163
Practice Address - Country:US
Practice Address - Phone:616-458-7978
Practice Address - Fax:616-458-3719
Is Sole Proprietor?:No
Enumeration Date:2023-03-10
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician