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Organization
SUPER OPTICAL EXPRESS
Active
Organization
SUPER OPTICAL EXPRESS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PAUL E FUNDERBURK O.D. (VICE PRESIDENT)
(352) 331-2040
Entity
Organization
Contact information
Practice address
6757 W NEWBERRY RD, GAINESVILLE, FL 32605-4312
(352) 331-2040
(352) 331-1526
Mailing address
6757 W NEWBERRY RD, GAINESVILLE, FL 32605-4312
(352) 331-2040
(352) 331-1526
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
796
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
084305900
—
FL
05
—
084871900
—
FL
Enumeration date
08/12/2008
Last updated
10/26/2011
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