Individual
MR. LESLIE M FUNKHOUSER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OPTICIAN
Contact information
Practice address
1260 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
156FX1800X
Optician
Primary
—
—
Other
Enumeration date
07/17/2006
Last updated
07/08/2007
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