Provider Demographics
NPI:1407922727
Name:DOCTORS GOFF & FALKNOR PA
Entity Type:Organization
Organization Name:DOCTORS GOFF & FALKNOR PA
Other - Org Name:ENVISION EYECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING ADMINISTRATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:KARA
Authorized Official - Middle Name:
Authorized Official - Last Name:FALKNOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-544-6700
Mailing Address - Street 1:PO BOX 3835
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79923-3835
Mailing Address - Country:US
Mailing Address - Phone:915-544-6700
Mailing Address - Fax:915-544-6707
Practice Address - Street 1:2222 MONTANA AVE
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79903-3602
Practice Address - Country:US
Practice Address - Phone:915-544-6700
Practice Address - Fax:915-544-6707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX093260003Medicaid
TX0079FAOtherBLUE CROSS BLUE SHIELD
TX00841WMedicare PIN
TX093260003Medicaid
TX4453620001Medicare NSC