Provider Demographics
NPI:1245301902
Name:FOSTER, MICHAEL A (OD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:A
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 1:2200 BOCA CHICA BLVD
Mailing Address - Street 2:#112
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78521-2212
Mailing Address - Country:US
Mailing Address - Phone:956-214-5018
Mailing Address - Fax:956-621-2984
Practice Address - Street 1:2200 BOCA CHICA BLVD # 112
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78521-2212
Practice Address - Country:US
Practice Address - Phone:956-214-5018
Practice Address - Fax:956-621-2984
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3631T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1457521916Medicaid
TX1457521916Medicaid