Provider Demographics
NPI:1457521916
Name:MICHAEL A FOSTER OD PA INC
Entity Type:Organization
Organization Name:MICHAEL A FOSTER OD PA INC
Other - Org Name:BROWNSVILLE EYE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:FOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:956-214-5018
Mailing Address - Street 1:2200 BOCA CHICA BLVD # 112
Mailing Address - Street 2:
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-11
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX03631T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1457521916Medicaid
TX=========OtherTAX IDENTIFICATION NUMBER