Provider Demographics
NPI:1043400062
Name:CAMPBELL-DEBERRY ENTERPRISES
Entity Type:Organization
Organization Name:CAMPBELL-DEBERRY ENTERPRISES
Other - Org Name:LAKESIDE VISION & OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STACY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:TURNER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:972-985-3638
Mailing Address - Street 1:4012 PRESTON ROAD
Mailing Address - Street 2:SUITE 500
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-7351
Mailing Address - Country:US
Mailing Address - Phone:872-985-3638
Mailing Address - Fax:972-867-7062
Practice Address - Street 1:4012 PRESTON ROAD
Practice Address - Street 2:SUITE 500
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-7351
Practice Address - Country:US
Practice Address - Phone:872-985-3638
Practice Address - Fax:972-867-7062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization