Provider Demographics
NPI:1104908474
Name:FALSONE, CHARLES J (OD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:J
Last Name:FALSONE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 KATHRYN ST
Mailing Address - Street 2:
Mailing Address - City:BOALSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16827-1646
Mailing Address - Country:US
Mailing Address - Phone:814-466-9093
Mailing Address - Fax:
Practice Address - Street 1:2790 EARLYSTOWN RD
Practice Address - Street 2:SUITE A
Practice Address - City:CENTRE HALL
Practice Address - State:PA
Practice Address - Zip Code:16828-9149
Practice Address - Country:US
Practice Address - Phone:814-364-1812
Practice Address - Fax:814-364-1813
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2009-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000392152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA034188R8MOtherGROUP MEMBER PROVIDER NUMBER
PA1720122732OtherGROUP NPI
PADD9538OtherPTAN
PA034188R8MOtherGROUP MEMBER PROVIDER NUMBER
6192130001Medicare NSC
PA074774Medicare PIN