Provider Demographics
NPI:1871788109
Name:JEFFREY S FOREMAN OD
Entity type:Organization
Organization Name:JEFFREY S FOREMAN OD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:FOREMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:515-955-7777
Mailing Address - Street 1:1511 1ST AVE S
Mailing Address - Street 2:
Mailing Address - City:FORT DODGE
Mailing Address - State:IA
Mailing Address - Zip Code:50501
Mailing Address - Country:US
Mailing Address - Phone:515-955-7777
Mailing Address - Fax:515-955-7082
Practice Address - Street 1:1511 1ST AVE S
Practice Address - Street 2:
Practice Address - City:FORT DODGE
Practice Address - State:IA
Practice Address - Zip Code:50501
Practice Address - Country:US
Practice Address - Phone:515-955-7777
Practice Address - Fax:515-955-7082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-10
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1739152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
410035679OtherRAILROAD MEDICARE
19661OtherBLUE CROSS
IA1196600Medicaid
IAI7477Medicare PIN
19661OtherBLUE CROSS
IAT01130Medicare UPIN