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General NPI Number Information
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NPI Number | 1649371550
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Entity Type | Organization
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Legal Business Name | CAMPBELL VISION CENTER, INC.
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Dates
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Enumeration Date | 09/25/2006
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Last Update Date | 10/27/2010
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Provider Practice Location Address
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Address Line | 14378 HIGHWAY 43
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City | RUSSELLVILLE
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State | AL
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Zip | 35653-2568
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Country | US
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Telephone | 256-332-1355
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Fax | 256-332-1315
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Provider Business Mailing Address
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Address Line | 14378 HIGHWAY 43
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City | RUSSELLVILLE
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State | AL
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Zip | 35653-2568
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Country | US
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Telephone | 256-332-1355
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Fax | 256-332-1315
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JEREMY S. CAMPBELL
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Credential | O.D.
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Telephone | 256-332-1355
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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 | S-A80-TA-660
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License Number State | AL
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