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General NPI Number Information
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NPI Number | 1356563803
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Entity Type | Organization
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Legal Business Name | FALLS OPTICAL, INC.
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 04/28/2022
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Provider Practice Location Address
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Address Line | 1850 1ST AVE NE
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City | LITTLE FALLS
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State | MN
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Zip | 56345-3381
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Country | US
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Telephone | 320-632-2391
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Fax | 320-632-2392
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Provider Business Mailing Address
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Address Line | 1850 1ST AVE NE
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City | LITTLE FALLS
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State | MN
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Zip | 56345-3381
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Country | US
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Telephone | 320-632-3291
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Fax | 320-632-2392
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KEN D DODGE
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Credential | OD
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Telephone | 320-224-5936
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 2809
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License Number State | MN
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