Provider Demographics
NPI:1740251867
Name:FOSTER, TERRY DON (OD)
Entity type:Individual
Prefix:DR
First Name:TERRY
Middle Name:DON
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 1:1301 CHOCTAW DR
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:TX
Mailing Address - Zip Code:75551-3006
Mailing Address - Country:US
Mailing Address - Phone:903-796-3349
Mailing Address - Fax:903-796-9071
Practice Address - Street 1:719 W MAIN ST
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:TX
Practice Address - Zip Code:75551-3425
Practice Address - Country:US
Practice Address - Phone:903-796-8288
Practice Address - Fax:903-796-9071
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4647TG152W00000X, 152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX410031278OtherRAILROAD MEDICARE
TXV0100686OtherDPS
TX82542EOtherBLUE CROSS/BLUE SHIELD
TX093216202Medicaid
AR97517OtherBLUE CROSS/BLUE SHIELD
LA1696633Medicaid
AR150773722Medicaid
AR150773722Medicaid
TX093216202Medicaid