Provider Demographics
NPI:1770610966
Name:FALLIS, CLAUD B (OD)
Entity type:Individual
Prefix:DR
First Name:CLAUD
Middle Name:B
Last Name:FALLIS
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 1:2650 VETERANS MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:ABBEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70510-4007
Mailing Address - Country:US
Mailing Address - Phone:337-898-0069
Mailing Address - Fax:337-898-0639
Practice Address - Street 1:2650 VETERANS MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:ABBEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70510-4007
Practice Address - Country:US
Practice Address - Phone:337-898-0069
Practice Address - Fax:337-898-0639
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA969069T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAP00960152OtherMEDICARE RAILROAD RETIREMENT
LA1364789Medicaid
LAT69513Medicare UPIN
LA47682Medicare PIN
LA1364789Medicaid