Healthcare Provider Details

I. General information

NPI: 1104908474
Provider Name (Legal Business Name): CHARLES J. FALSONE O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 05/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2790 EARLYSTOWN RD SUITE A
CENTRE HALL PA
16828-9149
US

IV. Provider business mailing address

1011 KATHRYN ST
BOALSBURG PA
16827-1646
US

V. Phone/Fax

Practice location:
  • Phone: 814-364-1812
  • Fax: 814-364-1813
Mailing address:
  • Phone: 814-466-9093
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG000392
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberOEG000392
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: