MEDICARE: FAMILY EYECARE NORTH, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	OEG-001598	PA

General Provider Information

NPI Number	:	1023529104
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY EYECARE NORTH, LLC

Provider Business Mailing Address
First Line	:	673 CASTLE CREEK DRIVE EXT
Second Line	:
City	:	SEVEN FIELDS
State	:	PA
Zip	:	16046-7864
Country	:	US
Telephone Number	:	724-778-3937
Fax Number	:

Provider Business Practice Location Address
First Line	:	673 CASTLE CREEK DRIVE EXT
Second Line	:
City	:	SEVEN FIELDS
State	:	PA
Zip	:	16046-7864
Country	:	US
Telephone Number	:	724-778-3937
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JOSEPH D. FALBO
Credential	:	OD
Telephone Number	:	724-518-9897

Provider Enumeration Date	:	10/17/2017
Last Update Date	:	10/17/2017

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