1730223868 NPI number — FALK OPTOMETRIC GROUP, INC

Table of content: (NPI 1730223868)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730223868 NPI number — FALK OPTOMETRIC GROUP, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FALK OPTOMETRIC GROUP, INC
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:
1730223868
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/10/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1593 HEADWATERS LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WOODBURY
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55129-6233
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
651-337-0374
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9925 HUDSON PL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WOODBURY
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55125
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
651-702-1231
Provider Business Practice Location Address Fax Number:
651-702-1239
Provider Enumeration Date:
02/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
FALK
Authorized Official First Name:
MICHELLE
Authorized Official Middle Name:
SHIH-MING
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
651-337-0374

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  2856 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 152W00000X , with the licence number: 2857 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 22 02293 . This is a "MEDICA-MICHELLE FALK, OD" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 189811043835 . This is a "PREFERRED ONE-M. FALK, OD" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 189811043836 . This is a "PREFERRED ONE-G FALK, OD" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 308T4SA . This is a "BLUE CROSS & BLUE SHIELD" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 22 02944 . This is a "MEDICA-GREGORY FALK, OD" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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