Healthcare Provider Details

I. General information

NPI: 1033684410
Provider Name (Legal Business Name): LAURA FALCO, O.D. LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2018
Last Update Date: 10/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2279 S UNIVERSITY DR
DAVIE FL
33324-5828
US

IV. Provider business mailing address

2279 S UNIVERSITY DR
DAVIE FL
33324-5828
US

V. Phone/Fax

Practice location:
  • Phone: 954-473-0100
  • Fax: 954-474-7832
Mailing address:
  • Phone: 954-473-0100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. LAURA ANGELA FALCO
Title or Position: OWNER
Credential: OD
Phone: 954-473-0100