Provider Demographics
NPI:1982928271
Name:FALCON, GINNY
Entity Type:Individual
Prefix:
First Name:GINNY
Middle Name:
Last Name:FALCON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10800 PINES BLVD STE 7
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33026-5216
Mailing Address - Country:US
Mailing Address - Phone:954-885-8488
Mailing Address - Fax:954-885-4919
Practice Address - Street 1:10800 PINES BLVD STE 7
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33026-5216
Practice Address - Country:US
Practice Address - Phone:954-885-8488
Practice Address - Fax:954-885-4919
Is Sole Proprietor?:No
Enumeration Date:2010-03-16
Last Update Date:2010-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4280156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician