Provider Demographics
NPI:1598594475
Name:FUNKHOUSER, EMILY (LDO)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:FUNKHOUSER
Suffix:
Gender:F
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:461 W RESERVOIR RD
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:VA
Mailing Address - Zip Code:22664-2005
Mailing Address - Country:US
Mailing Address - Phone:540-459-8901
Mailing Address - Fax:540-459-9470
Practice Address - Street 1:461 W RESERVOIR RD
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:VA
Practice Address - Zip Code:22664-2005
Practice Address - Country:US
Practice Address - Phone:540-459-8901
Practice Address - Fax:540-459-9470
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-30
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1101003426156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician