Provider Demographics
NPI:1730187279
Name:CAMPBELL, JOE H (OD LLC)
Entity type:Individual
Prefix:
First Name:JOE
Middle Name:H
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:OD LLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:946 BENSON ST
Mailing Address - Street 2:
Mailing Address - City:HARTWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30643-2023
Mailing Address - Country:US
Mailing Address - Phone:706-376-5471
Mailing Address - Fax:706-376-5483
Practice Address - Street 1:946 BENSON ST
Practice Address - Street 2:
Practice Address - City:HARTWELL
Practice Address - State:GA
Practice Address - Zip Code:30643-2023
Practice Address - Country:US
Practice Address - Phone:706-376-5471
Practice Address - Fax:706-376-5483
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT000938152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAU05910Medicare UPIN
GA41ZCGDXMedicare PIN