1750552469 NPI number — FORSTER EYE CARE, P.C.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750552469 NPI number — FORSTER EYE CARE, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FORSTER EYE CARE, P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1750552469
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/17/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
725 WALTHER RD
Provider Second Line Business Mailing Address:
BUILDING 100
Provider Business Mailing Address City Name:
LAWRENCEVILLE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30046-8725
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-513-3300
Provider Business Mailing Address Fax Number:
678-990-8252

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
725 WALTHER RD
Provider Second Line Business Practice Location Address:
BUILDING 100
Provider Business Practice Location Address City Name:
LAWRENCEVILLE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30045-8725
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-513-3300
Provider Business Practice Location Address Fax Number:
770-513-3350
Provider Enumeration Date:
03/20/2008

Additional Information

Authorized Official

Authorized Official Last Name:
FORSTER
Authorized Official First Name:
MARK
Authorized Official Middle Name:
JOSEPH
Authorized Official Title or Position:
OPTOMETRIST
Authorized Official Telephone Number:
770-513-3300

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  1383T , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 410044702 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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