Individual provider Active NPI

Kenneth Ray Falknor, O.D.

  • Optometrist
  • El Paso, TX
National Provider Identifier
1073516910
Registry record updated Jul 15, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
02538TG Issued in TX
Practice address
2222 Montana Ave
El Paso, TX 79903-3602
Phone
(915) 544-6700
Fax
(915) 544-6707
NPI assigned
May 24, 2005
Last updated
Jul 15, 2015By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 15, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 02538TG TX Primary
Corneal and Contact Management Optometrist 152WC0802X 2538TG TX

Addresses

Primary practice location

2222 Montana Ave
El Paso, TX 79903-3602

Mailing address

PO Box 3835
El Paso, TX 79923-3835
Phone (915) 544-6700

Other identifiers 2

IdentifierTypeStateIssuer
037029802MedicaidTX
80663QOtherTXBLUE CROSS BLUE SHIELD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040716000464 TX Practitioner - Optometry 7012996861 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
02538TGTXMDOptometrist
2538TGTXMDCorneal and Contact Management Optometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Aeg Texas Professional PLLC Optometrist CurrentSince Nov 19, 2021 Accepting new patients
Janet B Ogletree OD PA Optometrist PastSince Nov 1, 2016 Accepting new patients

Locations

7410 Remcon Cir
Ste K
El Paso, TX 79912
Phone (915) 587-9400

3551 Justin Rd
Ste 150
Flower Mound, TX 75028
Phone (210) 490-9205

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1116892800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1436918400000",
    "number": "1073516910",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3835",
            "city": "EL PASO",
            "state": "TX",
            "postal_code": "799233835",
            "telephone_number": "915-544-6700",
            "fax_number": "915-544-6707"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2222 MONTANA AVE",
            "city": "EL PASO",
            "state": "TX",
            "postal_code": "799033602",
            "telephone_number": "915-544-6700",
            "fax_number": "915-544-6707"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FALKNOR",
        "first_name": "KENNETH",
        "middle_name": "RAY",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-05-24",
        "last_updated": "2015-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "TX",
            "license": "02538TG",
            "primary": true
        },
        {
            "code": "152WC0802X",
            "taxonomy_group": "",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": "TX",
            "license": "2538TG",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "037029802",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "80663Q",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in El Paso, TX

Sources for this page

Verify at the official NPI Registry.