Provider Demographics
NPI:1497053029
Name:DUSK FALKNER-MARTINEZ, O.D., P.A.
Entity Type:Organization
Organization Name:DUSK FALKNER-MARTINEZ, O.D., P.A.
Other - Org Name:THE EYE SITE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DUSK
Authorized Official - Middle Name:JAYE
Authorized Official - Last Name:FALKNER-MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:954-916-0017
Mailing Address - Street 1:10187 W SUNRISE BLVD
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33322-7617
Mailing Address - Country:US
Mailing Address - Phone:954-916-0017
Mailing Address - Fax:954-306-8194
Practice Address - Street 1:10187 W SUNRISE BLVD
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33322-7617
Practice Address - Country:US
Practice Address - Phone:954-916-0017
Practice Address - Fax:954-306-8194
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-07
Last Update Date:2015-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 3110152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHN896AMedicare UPIN