Paul Edward Funderburk, O.D

Primary specialty

OptometristTaxonomy code 152W00000X

License

591711900 Issued in FL

Practice address

6757 W Newberry Rd
Gainesville, FL 32605-4312

Phone

(352) 331-2040

Fax

(352) 331-1526

NPI assigned

Jun 28, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Super Optical Express

  • Optometrist
  • Gainesville, FL
  • NPI 1639325434
  NPD (past) Authorized official
• Jose R Arnao O.D. P.a.

  • Optometrist
  • Gainesville, FL
  • NPI 1457630451
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1151452800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1296777600000",
    "number": "1376571752",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6757 W NEWBERRY RD",
            "city": "GAINESVILLE",
            "state": "FL",
            "postal_code": "326054312",
            "telephone_number": "352-331-2040",
            "fax_number": "352-331-1526"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6757 W NEWBERRY RD",
            "city": "GAINESVILLE",
            "state": "FL",
            "postal_code": "326054312",
            "telephone_number": "352-331-2040",
            "fax_number": "352-331-1526"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FUNDERBURK",
        "first_name": "PAUL",
        "middle_name": "EDWARD",
        "name_prefix": "Dr.",
        "credential": "O.D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-28",
        "last_updated": "2011-02-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "FL",
            "license": "591711900",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FLA LIC NUMBER",
            "identifier": "1269",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX ID",
            "identifier": "591711900",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "084871900",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lanesha Fulton
• Larry Fulton
• Shayna Fulton
• Melissa M Fults
• Holly Fundenburg, PTA
• Emily Marie Fundora
• Kevin M. Funez, MD
• James Funk
• Patricia Jean Funk, M.S., R.D., L.D.N.,
• Kathryn Funke, LICENSED SCHOOL PYSC

• Optometrist in Gainesville, FL
• Providers in Gainesville, FL by specialty
• Optometrist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.