MEDICARE: RANDOLPH JAY FALK M.D.

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	207W00000X	Ophthalmology Physician	C41643	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	C41643	OTHER	CA	CA MEDICAL LICENSE #
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043294507
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RANDOLPH JAY FALK M.D.

Provider Business Mailing Address
First Line	:	11030 VALLEY MALL
Second Line	:
City	:	EL MONTE
State	:	CA
Zip	:	91731-2617
Country	:	US
Telephone Number	:	626-444-4545
Fax Number	:	626-444-8989

Provider Business Practice Location Address
First Line	:	11030 VALLEY MALL
Second Line	:
City	:	EL MONTE
State	:	CA
Zip	:	91731-2617
Country	:	US
Telephone Number	:	626-444-4545
Fax Number	:	626-444-8989

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/30/2005
Last Update Date	:	02/10/2010

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