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NPI Code Detail

MEDICARE: DR. RYAN JAMES CAMPBELL OD

MEDICARE: DR. RYAN JAMES CAMPBELL OD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometrist27OA00706100NJ
2152W00000XOptometrist27M00173300NJ
3152W00000XOptometrist009360NY
4152W00000XOptometristTUV009360NY

General Provider Information

NPI Number : 1518537331
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RYAN JAMES CAMPBELL OD
Provider Business Mailing Address
First Line : 33 JADE CT
Second Line :
City : STATEN ISLAND
State : NY
Zip : 10309-2007
Country : US
Telephone Number : 718-887-1591
Fax Number :
Provider Business Practice Location Address
First Line : 23 OCEANIC AVE
Second Line :
City : STATEN ISLAND
State : NY
Zip : 10312-6511
Country : US
Telephone Number : 718-948-8880
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/25/2021
Last Update Date : 06/25/2021

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