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General NPI Number Information
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NPI Number | 1518537331
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Entity Type | Individual
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Provider Name | RYAN JAMES CAMPBELL OD
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Gender | Male
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Dates
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Enumeration Date | 06/25/2021
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Last Update Date | 06/25/2021
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Provider Practice Location Address
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Address Line | 23 OCEANIC AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10312-6511
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Country | US
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Telephone | 718-948-8880
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Fax |
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Provider Business Mailing Address
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Address Line | 33 JADE CT
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City | STATEN ISLAND
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State | NY
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Zip | 10309-2007
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Country | US
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Telephone | 718-887-1591
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 27OA00706100
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 27M00173300
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 009360
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License Number State | NY
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Taxonomy #4
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | TUV009360
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License Number State | NY
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