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Individual
DR. THOMAS ROY FUNNELL
Active
Individual
DR. THOMAS ROY FUNNELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OPT 6924 TPA
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3159
MEDICAL EYE SERVICES
AR
01
—
576380382
VISION SERVICE PLAN
CA
05
—
SD0069240
—
CA
Enumeration date
08/30/2006
Last updated
07/08/2007
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