Organization
FUNKHOUSER OPTICIANS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LESLIE MELVIN FUNKHOUSER (OWNER)
(903) 677-1985
Entity
Organization
Contact information
Practice address
1206 S PALESTINE ST, ATHENS, TX 75751-3619
(903) 677-1985
(903) 677-2099
Mailing address
PO BOX 952, ATHENS, TX 75751-0952
(903) 677-1985
(903) 677-2099
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
066298301
—
TX
05
—
149257101
—
TX
01
—
528354
BCBS OF TX
—
Enumeration date
01/08/2008
Last updated
05/21/2008
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