Provider Demographics
NPI:1891798534
Name:FALKNOR, LARRY W (OD)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:W
Last Name:FALKNOR
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: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
Is Sole Proprietor?:No
Enumeration Date:2005-05-26
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX02458TG152WC0802X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX093522303Medicaid
TX80665QOtherBLUE CROSS BLUE SHIELD
TX8B9573Medicare PIN
TX80665QOtherBLUE CROSS BLUE SHIELD
TXP00182618Medicare PIN
TX093522303Medicaid