Provider Demographics
NPI:1972151652
Name:FUNNELL, COLIN SIMMONS (OD)
Entity Type:Individual
Prefix:DR
First Name:COLIN
Middle Name:SIMMONS
Last Name:FUNNELL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1445 DONLON ST STE 12
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-8390
Mailing Address - Country:US
Mailing Address - Phone:805-624-3777
Mailing Address - Fax:805-644-6491
Practice Address - Street 1:1445 DONLON ST STE 12
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-8390
Practice Address - Country:US
Practice Address - Phone:805-642-3777
Practice Address - Fax:805-644-6491
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-27
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34354TLG152WC0802X, 152WP0200X, 152WV0400X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy