Provider Demographics
NPI:1114908076
Name:FALK, AMY DUNN (OD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:DUNN
Last Name:FALK
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 MAIN ST
Mailing Address - Street 2:STE 300
Mailing Address - City:EAST GREENWICH
Mailing Address - State:RI
Mailing Address - Zip Code:02818-3827
Mailing Address - Country:US
Mailing Address - Phone:401-398-0669
Mailing Address - Fax:401-541-5199
Practice Address - Street 1:16 MAIN ST STE 300
Practice Address - Street 2:
Practice Address - City:EAST GREENWICH
Practice Address - State:RI
Practice Address - Zip Code:02818-3827
Practice Address - Country:US
Practice Address - Phone:401-227-5300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2019-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4426152W00000X
RIODTA00514152W00000X
RIODTG00579152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0703842Medicaid
RIAF81463Medicaid
V05830Medicare UPIN