1720122732 NPI number — CHARLES J. FALSONE P.C.

Table of content: (NPI 1720122732)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720122732 NPI number — CHARLES J. FALSONE P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHARLES J. FALSONE 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:
IN FOCUS FAMILY VISION
Provider Other Organization Name Type Code:
3
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:
1720122732
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/11/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1011 KATHRYN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOALSBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16827-1646
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-466-9093
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2790 EARLYSTOWN RD
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
CENTRE HALL
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16828-9149
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-364-1812
Provider Business Practice Location Address Fax Number:
814-364-1813
Provider Enumeration Date:
02/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
FALSONE
Authorized Official First Name:
CHARLES
Authorized Official Middle Name:
J.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
814-364-1812

Provider Taxonomy Codes

  • Taxonomy code: 152WC0802X , with the licence number:  OEG 000392 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: DD9538 . This is a "PTAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1104908474 . This is a "GROUP MEMBER NPI" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 034188R8M . This is a "GROUP MEMBER PROVIDER NUMBER" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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