Provider Demographics
NPI:1740275452
Name:FUNK, MARTIN R (OD)
Entity type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:R
Last Name:FUNK
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:PO BOX 497
Mailing Address - Street 2:
Mailing Address - City:CHANUTE
Mailing Address - State:KS
Mailing Address - Zip Code:66720-0497
Mailing Address - Country:US
Mailing Address - Phone:620-431-2300
Mailing Address - Fax:
Practice Address - Street 1:1 E 2ND ST
Practice Address - Street 2:
Practice Address - City:CHANUTE
Practice Address - State:KS
Practice Address - Zip Code:66720-2460
Practice Address - Country:US
Practice Address - Phone:620-431-2300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-19
Last Update Date:2011-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1351-3152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100219180AMedicaid
U21925Medicare UPIN
KS100219180AMedicaid
017099Medicare PIN