Manhattan Beach Vision Group Inc

Primary specialty

Corneal and Contact Management OptometristTaxonomy code 152WC0802X

License

OPT6029 Issued in CA

Legal business name

MANHATTAN BEACH VISION GROUP INC

Practice address

946 Manhattan Beach Blvd
Manhattan Beach, CA 90266-5120

Phone

(310) 545-4585

Fax

(310) 546-3240

NPI assigned

Apr 6, 2007

Organization subpart

No

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

Authorized official

Name

John Walter Funnell, OD

Title

Owner

Phone

(310) 545-4585

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1175817600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1902929946",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "946 MANHATTAN BEACH BLVD",
            "city": "MANHATTAN BEACH",
            "state": "CA",
            "postal_code": "902665120",
            "telephone_number": "310-545-4585",
            "fax_number": "310-546-3240"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "946 MANHATTAN BEACH BLVD",
            "city": "MANHATTAN BEACH",
            "state": "CA",
            "postal_code": "902665120",
            "telephone_number": "310-545-4585",
            "fax_number": "310-546-3240"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MANHATTAN BEACH VISION GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-06",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "FUNNELL",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "WALTER",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "310-545-4585",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152WC0802X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": "CA",
            "license": "OPT6029",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OPT6029",
            "identifier": "LICENSE",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Corneal and Contact Management Optometrist in Manhattan Beach, CA
• Providers in Manhattan Beach, CA by specialty
• Corneal and Contact Management Optometrist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.