Provider Demographics
NPI:1770575276
Name:FOSTER, DAVID H (OD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:H
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 1:2504 PERKIOMEN AVE
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19606-2052
Mailing Address - Country:US
Mailing Address - Phone:610-779-9636
Mailing Address - Fax:610-779-9671
Practice Address - Street 1:2504 PERKIOMEN AVE
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19606-2052
Practice Address - Country:US
Practice Address - Phone:610-779-9636
Practice Address - Fax:610-779-9671
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-19
Last Update Date:2016-03-22
Deactivation Date:2006-03-25
Deactivation Code:
Reactivation Date:2006-04-06
Provider Licenses
StateLicense IDTaxonomies
PAOEG000151152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0020564000OtherINDEPENDENCE BLUE CROSS
PA01904729Medicaid
PA0865740001Medicare NSC
PA0020564000OtherINDEPENDENCE BLUE CROSS
PAT28435Medicare UPIN