Provider Demographics
NPI:1730223868
Name:FALK OPTOMETRIC GROUP, INC
Entity type:Organization
Organization Name:FALK OPTOMETRIC GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:SHIH-MING
Authorized Official - Last Name:FALK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:651-337-0374
Mailing Address - Street 1:1593 HEADWATERS LN
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55129-6233
Mailing Address - Country:US
Mailing Address - Phone:651-337-0374
Mailing Address - Fax:
Practice Address - Street 1:9925 HUDSON PL
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125
Practice Address - Country:US
Practice Address - Phone:651-702-1231
Practice Address - Fax:651-702-1239
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2018-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2857152W00000X
MN2856152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN22 02293OtherMEDICA-MICHELLE FALK, OD
MN189811043835OtherPREFERRED ONE-M. FALK, OD
MN189811043836OtherPREFERRED ONE-G FALK, OD
MN308T4SAOtherBLUE CROSS & BLUE SHIELD
MN22 02944OtherMEDICA-GREGORY FALK, OD
MN308T4SAOtherBLUE CROSS & BLUE SHIELD
MN308T4SAOtherBLUE CROSS & BLUE SHIELD