Provider Demographics
NPI:1114403649
Name:FUNARI, KATHARINE (OD)
Entity Type:Individual
Prefix:
First Name:KATHARINE
Middle Name:
Last Name:FUNARI
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6420 GREENLEIGH AVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLE RIVER
Mailing Address - State:MD
Mailing Address - Zip Code:21220-2052
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:240-482-1105
Practice Address - Street 1:6430 ROCKLEDGE DR STE 600
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817-7813
Practice Address - Country:US
Practice Address - Phone:240-482-1100
Practice Address - Fax:240-482-1105
Is Sole Proprietor?:No
Enumeration Date:2018-07-18
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA2664152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDTA2664OtherMD LICENSE