Provider Demographics
NPI:1881720910
Name:ROBERT FOERSTER OPTICIAN, INC.
Entity type:Organization
Organization Name:ROBERT FOERSTER OPTICIAN, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:FOERSTER
Authorized Official - Suffix:
Authorized Official - Credentials:OPTICIAN
Authorized Official - Phone:609-641-5747
Mailing Address - Street 1:201 TILTON RD
Mailing Address - Street 2:STORE 16
Mailing Address - City:NORTHFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:08225-1247
Mailing Address - Country:US
Mailing Address - Phone:609-641-5747
Mailing Address - Fax:609-641-3990
Practice Address - Street 1:2327 NEW RD
Practice Address - Street 2:SUITE # 103
Practice Address - City:NORTHFIELD
Practice Address - State:NJ
Practice Address - Zip Code:08225-1433
Practice Address - Country:US
Practice Address - Phone:609-641-5747
Practice Address - Fax:609-641-3990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-25
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ31TD00146500156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0387510001Medicare ID - Type UnspecifiedPROVIDER #