Healthcare Provider Details

I. General information

NPI: 1306839881
Provider Name (Legal Business Name): MICHAEL ALLEN CAMPBELL O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2005
Last Update Date: 06/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 HOSPITAL CENTER CMNS STE 100
HILTON HEAD ISLAND SC
29926-2839
US

IV. Provider business mailing address

10 HOSPITAL CENTER CMNS STE 100
HILTON HEAD ISLAND SC
29926-2839
US

V. Phone/Fax

Practice location:
  • Phone: 843-681-6682
  • Fax: 681-681-9582
Mailing address:
  • Phone: 843-681-6682
  • Fax: 681-681-9582

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number841
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: