MEDICARE: DR. JUSTIN CAMPBELL O.D.

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
1	152W00000X	Optometrist	1512	SC

General Provider Information

NPI Number	:	1568510485
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUSTIN CAMPBELL O.D.

Provider Business Mailing Address
First Line	:	280 HARBISON BLVD STE T
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29212-2247
Country	:	US
Telephone Number	:	803-732-9200
Fax Number	:	803-732-1319

Provider Business Practice Location Address
First Line	:	280 HARBISON BLVD STE T
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29212-2247
Country	:	US
Telephone Number	:	803-732-9200
Fax Number	:	803-732-1319

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/08/2007
Last Update Date	:	02/10/2010

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