Provider Demographics
NPI:1396819132
Name:FALCO, LAURA ANGELA (OD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:ANGELA
Last Name:FALCO
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 1:2279 S UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33324-5828
Mailing Address - Country:US
Mailing Address - Phone:954-473-0100
Mailing Address - Fax:
Practice Address - Street 1:2279 S UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33324-5828
Practice Address - Country:US
Practice Address - Phone:954-473-0100
Practice Address - Fax:954-262-1818
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC3462152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL620566600Medicaid
FLE7920Medicare ID - Type Unspecified