1528305760 NPI number — DRS. FUNDERBURK & PRICE, OD PA

Table of content: (NPI 1528305760)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528305760 NPI number — DRS. FUNDERBURK & PRICE, OD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DRS. FUNDERBURK & PRICE, OD PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
BESSEMER CITY EYECARE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1528305760
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/04/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 23299
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MINT HILL
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28227-0275
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-545-9797
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
136 W VIRGINIA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BESSEMER CITY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28016-2373
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-629-2671
Provider Business Practice Location Address Fax Number:
704-629-2671
Provider Enumeration Date:
01/08/2013

Additional Information

Authorized Official

Authorized Official Last Name:
FUNDERBURK
Authorized Official First Name:
PHILIP
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
704-545-9797

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  922 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com