Healthcare Provider Details

I. General information

NPI: 1255335113
Provider Name (Legal Business Name): FRANCIS FALCK M.D., PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 WASHINGTON ST
MYSTIC CT
06355-2816
US

IV. Provider business mailing address

35 WASHINGTON ST
MYSTIC CT
06355-2816
US

V. Phone/Fax

Practice location:
  • Phone: 860-572-2020
  • Fax: 860-572-2000
Mailing address:
  • Phone: 860-572-2020
  • Fax: 860-572-2000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number033284
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: