Provider Demographics
NPI:1245668201
Name:H. KIRK FALLIN, O.D. & ASSOCIATES, P.A.,
Entity type:Organization
Organization Name:H. KIRK FALLIN, O.D. & ASSOCIATES, P.A.,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:HERBERT
Authorized Official - Middle Name:KIRK
Authorized Official - Last Name:FALLIN
Authorized Official - Suffix:III
Authorized Official - Credentials:OD
Authorized Official - Phone:941-923-4111
Mailing Address - Street 1:8201 S TAMIAMI TRL UNIT 51
Mailing Address - Street 2:SUITE 51
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34238-2950
Mailing Address - Country:US
Mailing Address - Phone:941-923-4111
Mailing Address - Fax:941-926-2981
Practice Address - Street 1:8201 S TAMIAMI TRL UNIT 51
Practice Address - Street 2:SUITE 51
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34238-2950
Practice Address - Country:US
Practice Address - Phone:941-923-4111
Practice Address - Fax:941-926-2981
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-29
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC3228152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE4225Medicare PIN
FLU72743Medicare UPIN