Provider Demographics
NPI:1467647198
Name:MCFALL-FIALKO, HILDA ANN
Entity Type:Individual
Prefix:
First Name:HILDA
Middle Name:ANN
Last Name:MCFALL-FIALKO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 NW HWY 19
Mailing Address - Street 2:SUITE 165
Mailing Address - City:CRYSTAL RIVER
Mailing Address - State:FL
Mailing Address - Zip Code:34428-6119
Mailing Address - Country:US
Mailing Address - Phone:352-795-2020
Mailing Address - Fax:352-795-7432
Practice Address - Street 1:827 SW KINGSBAY DRIVE
Practice Address - Street 2:
Practice Address - City:CRYSTAL RIVER
Practice Address - State:FL
Practice Address - Zip Code:34429
Practice Address - Country:US
Practice Address - Phone:352-795-2020
Practice Address - Fax:352-795-7432
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-06
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL203289691156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL078546600Medicaid
FL078546600Medicaid