Healthcare Provider Details

I. General information

NPI: 1821056706
Provider Name (Legal Business Name): WILLIAM J FAULKNER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2006
Last Update Date: 07/14/2021
Certification Date: 07/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 MADISON AVE
COVINGTON KY
41011-3313
US

IV. Provider business mailing address

1945 CEI DRIVE
CINCINNATI OH
45242-3311
US

V. Phone/Fax

Practice location:
  • Phone: 859-655-6100
  • Fax:
Mailing address:
  • Phone: 513-569-3741
  • Fax: 513-569-3941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number35044577
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number31051
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: