MEDICARE: FALCO R ODORISIO BC-HIS,ACA

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	237600000X	Audiologist-Hearing Aid Fitter		FL
2	237700000X	Hearing Instrument Specialist	AS1737	FL

General Provider Information

NPI Number	:	1750424172
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FALCO R ODORISIO BC-HIS,ACA

Provider Business Mailing Address
First Line	:	6700 WASHINGTON AVE S
Second Line	:
City	:	EDEN PRAIRIE
State	:	MN
Zip	:	55344-3405
Country	:	US
Telephone Number	:	612-351-1529
Fax Number	:

Provider Business Practice Location Address
First Line	:	269 S FEDERAL HWY
Second Line	:
City	:	DEERFIELD BCH
State	:	FL
Zip	:	33441-4161
Country	:	US
Telephone Number	:	954-426-2500
Fax Number	:	954-426-3797

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

Provider Enumeration Date	:	02/15/2007
Last Update Date	:	04/11/2019

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