Provider Demographics
NPI:1295895795
Name:FAKLIS ORTHOPEDIC SERVICES
Entity type:Organization
Organization Name:FAKLIS ORTHOPEDIC SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, OTHOTIST
Authorized Official - Prefix:
Authorized Official - First Name:VASILE
Authorized Official - Middle Name:G
Authorized Official - Last Name:FAKLIS
Authorized Official - Suffix:
Authorized Official - Credentials:CO, BOCO
Authorized Official - Phone:727-938-1525
Mailing Address - Street 1:139 E TARPON AVE
Mailing Address - Street 2:
Mailing Address - City:TARPON SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34689-3451
Mailing Address - Country:US
Mailing Address - Phone:727-938-1525
Mailing Address - Fax:727-938-1669
Practice Address - Street 1:139 E TARPON AVE
Practice Address - Street 2:
Practice Address - City:TARPON SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34689-3451
Practice Address - Country:US
Practice Address - Phone:727-938-1525
Practice Address - Fax:727-938-1669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2007-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLORT 84335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL021837500Medicaid
FL0837930001Medicare NSC