Provider Demographics
NPI:1083676845
Name:CAMPBELL, CHAD H (OD)
Entity Type:Individual
Prefix:DR
First Name:CHAD
Middle Name:H
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 1:3651 NEW HERITAGE CIRCLE
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84088-5076
Mailing Address - Country:US
Mailing Address - Phone:801-282-4826
Mailing Address - Fax:
Practice Address - Street 1:6191 S STATE ST
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-7258
Practice Address - Country:US
Practice Address - Phone:801-268-0937
Practice Address - Fax:801-281-4281
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-05
Last Update Date:2009-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT56755659934152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist