Sam R. Funk, O.D., P.a.

Primary specialty

OptometristTaxonomy code 152W00000X

License

11113 Issued in KS

Legal business name

SAM R. FUNK, O.D., P.A.

Practice address

505 N Franklin Ave Ste B
Colby, KS 67701-2342

Phone

(785) 462-3348

Fax

(785) 462-3599

NPI assigned

Aug 22, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Sam R Funk, ODNPI 1982037396

Title

Optometrist

Phone

(785) 462-3348

Specialties & licenses 1

Addresses

Other identifiers 6

Medicare fee-for-service enrollment

Enrolled in KS2 enrollments

Enrollment records 2

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Sam Rodger Funk, O.D.

  • Optometrist
  • Colby, KS
  • NPI 1982037396
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1156204800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1456272000000",
    "number": "1467568519",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "505 N FRANKLIN AVE STE B",
            "city": "COLBY",
            "state": "KS",
            "postal_code": "677012342",
            "telephone_number": "785-462-3348",
            "fax_number": "785-462-3599"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "505 N FRANKLIN AVE STE B",
            "city": "COLBY",
            "state": "KS",
            "postal_code": "677012342",
            "telephone_number": "785-462-3348",
            "fax_number": "785-462-3599"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAM R. FUNK, O.D., P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-22",
        "last_updated": "2016-02-24",
        "status": "A",
        "authorized_official_last_name": "FUNK",
        "authorized_official_first_name": "SAM",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OPTOMETRIST",
        "authorized_official_telephone_number": "785-462-3348",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "KS",
            "license": "11113",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "12589230",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201083380A",
            "state": "KS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100090170A",
            "state": "KS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIRST GUARD",
            "identifier": "656990",
            "state": "KS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS",
            "identifier": "005149",
            "state": "KS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "001269",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Optometrist in Colby, KS
• Providers in Colby, KS by specialty
• Optometrist in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.