Provider Demographics
NPI:1649371550
Name:CAMPBELL VISION CENTER, INC.
Entity type:Organization
Organization Name:CAMPBELL VISION CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:S
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:256-332-1355
Mailing Address - Street 1:14378 HIGHWAY 43
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35653-2568
Mailing Address - Country:US
Mailing Address - Phone:256-332-1355
Mailing Address - Fax:256-332-1315
Practice Address - Street 1:14378 HIGHWAY 43
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AL
Practice Address - Zip Code:35653-2568
Practice Address - Country:US
Practice Address - Phone:256-332-1355
Practice Address - Fax:256-332-1315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2010-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS-A80-TA-660152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009940024Medicaid
AL529930260Medicaid
AL051537331Medicare PIN
AL529930260Medicaid
AL009940024Medicaid
ALV05239Medicare UPIN