Provider Demographics
NPI:1801418157
Name:FUNG, SAMANTHA NIKI (OD)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:NIKI
Last Name:FUNG
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 1:37670 GARFIELD ROAD
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48036
Mailing Address - Country:US
Mailing Address - Phone:586-939-1122
Mailing Address - Fax:586-939-9328
Practice Address - Street 1:37670 GARFIELD ROAD
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48036
Practice Address - Country:US
Practice Address - Phone:586-939-1122
Practice Address - Fax:586-939-9328
Is Sole Proprietor?:No
Enumeration Date:2020-05-09
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV009200152W00000X
MI4901005559152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist