Healthcare Provider Details

I. General information

NPI: 1881680635
Provider Name (Legal Business Name): ANTHONY F. CAMPANA OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2005
Last Update Date: 03/08/2024
Certification Date: 03/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 RIVER AVE
WILLIAMSPORT PA
17701-3722
US

IV. Provider business mailing address

435 RIVER AVE
WILLIAMSPORT PA
17701-3722
US

V. Phone/Fax

Practice location:
  • Phone: 866-995-3937
  • Fax: 570-966-5586
Mailing address:
  • Phone: 866-995-3937
  • Fax: 570-966-5586

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG000364
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: