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General NPI Number Information
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NPI Number | 1467568519
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Entity Type | Organization
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Legal Business Name | SAM R. FUNK, O.D., P.A.
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Dates
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Enumeration Date | 08/22/2006
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Last Update Date | 02/24/2016
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Provider Practice Location Address
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Address Line | 505 N FRANKLIN AVE STE B
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City | COLBY
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State | KS
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Zip | 67701-2342
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Country | US
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Telephone | 785-462-3348
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Fax | 785-462-3599
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Provider Business Mailing Address
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Address Line | 505 N FRANKLIN AVE STE B
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City | COLBY
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State | KS
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Zip | 67701-2342
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Country | US
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Telephone | 785-462-3348
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Fax | 785-462-3599
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. SAM R FUNK
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Credential | OD
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Telephone | 785-462-3348
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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 | 11113
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License Number State | KS
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