Provider Demographics
NPI:1861696387
Name:CAMPOS, ELISA A (DO)
Entity type:Individual
Prefix:MS
First Name:ELISA
Middle Name:A
Last Name:CAMPOS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8635 NW 8TH ST
Mailing Address - Street 2:APT #214
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-5952
Mailing Address - Country:US
Mailing Address - Phone:305-951-6266
Mailing Address - Fax:
Practice Address - Street 1:8635 NW 8TH ST
Practice Address - Street 2:APT #214
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-5952
Practice Address - Country:US
Practice Address - Phone:305-951-6266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1566156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician