Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 02538TG | TX |
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 2538TG | TX |
NPI | 1073516910 |
---|---|
Provider Name | Dr. Kenneth Ray Falknor |
First Address | El Paso, TX 79923-3835 |
Second Address | El Paso, TX 79903-3602 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2005 |
Last Update Date | 15/07/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
037029802 | (05) | TX |
80663Q | BLUE CROSS BLUE SHIELD (01) | TX |
T13220 | (02) | TX |