Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | OEG000392 | PA |
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | OEG000392 | PA |
NPI | 1104908474 |
---|---|
Provider Name | Dr. Charles J. Falsone |
First Address | Boalsburg, PA 16827-1646 |
Second Address | Centre Hall, PA 16828-9149 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/10/2006 |
Last Update Date | 11/05/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
034188R8M | GROUP MEMBER PROVIDER NUMBER (01) | PA |
1720122732 | GROUP NPI (01) | PA |
DD9538 | PTAN (01) | PA |
U78620 | (02) | PA |