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Individual

GARY R. FUNK

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
O.D.

Contact information

Practice address
7862 EL CAJON BLVD, LA MESA, CA 91942-6712
(619) 644-6405
(619) 461-5158
Mailing address
7862 EL CAJON BLVD, LA MESA, CA 91942-6712
(619) 644-6405
(619) 461-5158

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OPT7802T
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
SD0078020
CA
Enumeration date
08/09/2006
Last updated
06/19/2013
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