Provider Demographics
NPI:1619315421
Name:FALK, PETER RICHARD (OD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:RICHARD
Last Name:FALK
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3341 8TH ST S
Mailing Address - Street 2:
Mailing Address - City:WISCONSIN RAPIDS
Mailing Address - State:WI
Mailing Address - Zip Code:54494-6566
Mailing Address - Country:US
Mailing Address - Phone:715-423-5353
Mailing Address - Fax:715-423-6525
Practice Address - Street 1:3341 8TH ST S
Practice Address - Street 2:
Practice Address - City:WISCONSIN RAPIDS
Practice Address - State:WI
Practice Address - Zip Code:54494-6566
Practice Address - Country:US
Practice Address - Phone:715-423-5353
Practice Address - Fax:715-423-6525
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-13
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3298-35152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100075919Medicaid