Provider Demographics
NPI:1811989262
Name:FALK, PAMELA VERONICA (OD)
Entity type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:VERONICA
Last Name:FALK
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1032 S CHANTILLY ST
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92806-5026
Mailing Address - Country:US
Mailing Address - Phone:714-325-2522
Mailing Address - Fax:
Practice Address - Street 1:1201 W LA VETA AVE
Practice Address - Street 2:STE 406
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-4213
Practice Address - Country:US
Practice Address - Phone:714-558-8666
Practice Address - Fax:714-538-1142
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACAOPT9239T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist