Healthcare Provider Details

I. General information

NPI: 1265558365
Provider Name (Legal Business Name): CARRIE ELISABETH CAMPBELL OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 06/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15955 FM 529 RD
HOUSTON TX
77095-2513
US

IV. Provider business mailing address

15955 FM 529 RD
HOUSTON TX
77095-2513
US

V. Phone/Fax

Practice location:
  • Phone: 281-542-2086
  • Fax:
Mailing address:
  • Phone: 832-515-1839
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number5910TG
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: