Provider Demographics
NPI:1720174725
Name:FALLS EYECARE
Entity Type:Organization
Organization Name:FALLS EYECARE
Other - Org Name:JIM SAURDIFF GEN PTR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:L
Authorized Official - Last Name:SAURDIFF
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:218-283-2525
Mailing Address - Street 1:621 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:INTL FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56649-2637
Mailing Address - Country:US
Mailing Address - Phone:218-283-2525
Mailing Address - Fax:218-283-9694
Practice Address - Street 1:621 3RD AVE
Practice Address - Street 2:
Practice Address - City:INTL FALLS
Practice Address - State:MN
Practice Address - Zip Code:56649-2637
Practice Address - Country:US
Practice Address - Phone:218-283-2525
Practice Address - Fax:218-283-9694
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty