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General NPI Number Information
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NPI Number | 1295957892
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Entity Type | Organization
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Legal Business Name | D K FUNKHOUSER OD SC
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 6658 ODANA ROAD
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City | MADISON
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State | WI
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Zip | 53719
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Country | US
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Telephone | 608-220-7167
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Fax |
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Provider Business Mailing Address
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Address Line | 5834 LAKE EDGE ROAD
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City | MCFARLAND
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State | WI
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Zip | 53558
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Country | US
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Telephone | 608-220-7167
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Fax |
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Authorized Official
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Title or Position | DIRECT OWNER
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Name | DEANNE KAY FUNKHOUSER
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Credential | O.D.
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Telephone | 608-220-7167
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 2216
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License Number State | WI
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