Basic Information
| Provider Information | |||||||||
| NPI: | 1700050366 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DRS. FUNDERBURK AND PRICE, OD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 23299 | ||||||||
| Address2: | |||||||||
| City: | MINT HILL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282270275 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7045459797 | ||||||||
| FaxNumber: | 7045453111 | ||||||||
| Practice Location | |||||||||
| Address1: | 7749 MATTHEWS MINT HILL RD | ||||||||
| Address2: | |||||||||
| City: | MINT HILL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282277598 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7045459797 | ||||||||
| FaxNumber: | 7045453111 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/15/2008 | ||||||||
| LastUpdateDate: | 04/15/2008 | ||||||||
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| AuthorizedOfficialLastName: | FUNDERBURK | ||||||||
| AuthorizedOfficialFirstName: | PHILIP | ||||||||
| AuthorizedOfficialMiddleName: | B | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7045459797 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | OD | ||||||||
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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.