Provider Demographics
NPI:1033457494
Name:CAMPBELL, SOLOMON (OD)
Entity Type:Individual
Prefix:
First Name:SOLOMON
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:742 N 530 E
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84097-4104
Mailing Address - Country:US
Mailing Address - Phone:801-224-4799
Mailing Address - Fax:801-434-4051
Practice Address - Street 1:209 N STATE ST
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84057-4745
Practice Address - Country:US
Practice Address - Phone:801-224-4799
Practice Address - Fax:801-434-4051
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-19
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8706878-9934152W00000X
NVNV 759152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1033457494Medicaid
UT1033457494Medicaid