Organization
BARRY L FALLESEN
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BARRY L FALLESEN (OPTOMETRIST)
(530) 846-2697
Entity
Organization
Contact information
Practice address
235 SPRUCE ST, GRIDLEY, CA 95948-2215
(530) 846-2697
(530) 846-6426
Mailing address
235 SPRUCE ST, GRIDLEY, CA 95948-2215
(530) 846-2697
(530) 846-6426
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OPT6911TPL
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
SD0069110
—
CA
Enumeration date
11/05/2009
Last updated
11/03/2010
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