Provider Demographics
NPI:1528305760
Name:DRS. FUNDERBURK & PRICE, OD PA
Entity type:Organization
Organization Name:DRS. FUNDERBURK & PRICE, OD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:
Authorized Official - Last Name:FUNDERBURK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:704-545-9797
Mailing Address - Street 1:PO BOX 23299
Mailing Address - Street 2:
Mailing Address - City:MINT HILL
Mailing Address - State:NC
Mailing Address - Zip Code:28227-0275
Mailing Address - Country:US
Mailing Address - Phone:704-545-9797
Mailing Address - Fax:
Practice Address - Street 1:136 W VIRGINIA AVE
Practice Address - Street 2:
Practice Address - City:BESSEMER CITY
Practice Address - State:NC
Practice Address - Zip Code:28016-2373
Practice Address - Country:US
Practice Address - Phone:704-629-2671
Practice Address - Fax:704-629-2671
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-08
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC922152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty