Healthcare Provider Details

I. General information

NPI: 1780241695
Provider Name (Legal Business Name): GREGORY FALDOWSKI O D
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2019
Last Update Date: 06/03/2025
Certification Date: 06/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10775 PIONEER TRL STE 104
TRUCKEE CA
96161-0233
US

IV. Provider business mailing address

3352 CHARLOTTE AVE
ROSEMEAD CA
91770-2508
US

V. Phone/Fax

Practice location:
  • Phone: 530-721-2872
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: GREGORY J FALDOWSKI
Title or Position: PRESIDENT
Credential: O.D.
Phone: 775-375-8869