Provider Demographics
NPI:1497314322
Name:FUNKHOUSER, MEGAN ELIZABETH (OD)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:ELIZABETH
Last Name:FUNKHOUSER
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 1:8403 FLOYD CURL DR RM 1.110
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3904
Mailing Address - Country:US
Mailing Address - Phone:210-567-8600
Mailing Address - Fax:210-567-8609
Practice Address - Street 1:8403 FLOYD CURL DR RM 1.110
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3904
Practice Address - Country:US
Practice Address - Phone:210-567-8600
Practice Address - Fax:210-567-8609
Is Sole Proprietor?:No
Enumeration Date:2019-06-13
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9699152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX400979703OtherCSHCN
TX400979702Medicaid