Basic Information
| Provider Information | |||||||||
| NPI: | 1528305760 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | DRS. FUNDERBURK & PRICE, OD PA | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | BESSEMER CITY EYECARE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 23299 | ||||||||
| Address2: | |||||||||
| City: | MINT HILL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282270275 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7045459797 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 136 W VIRGINIA AVE | ||||||||
| Address2: | |||||||||
| City: | BESSEMER CITY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280162373 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7046292671 | ||||||||
| FaxNumber: | 7046292671 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/08/2013 | ||||||||
| LastUpdateDate: | 11/04/2013 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | FUNDERBURK | ||||||||
| AuthorizedOfficialFirstName: | PHILIP | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7045459797 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | OD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 922 | NC | Y | 193400000X SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
No ID Information.