Provider Demographics
NPI:1114908381
Name:CAMPBELL, KRISTIN L (OD)
Entity Type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:L
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 LEXINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:DELAWARE
Mailing Address - State:OH
Mailing Address - Zip Code:43015-4071
Mailing Address - Country:US
Mailing Address - Phone:740-369-2020
Mailing Address - Fax:740-369-0731
Practice Address - Street 1:12 LEXINGTON BLVD
Practice Address - Street 2:
Practice Address - City:DELAWARE
Practice Address - State:OH
Practice Address - Zip Code:43015-4071
Practice Address - Country:US
Practice Address - Phone:740-369-2020
Practice Address - Fax:740-369-0731
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-07
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4444 T1168152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1279940001OtherADMINISTAR FEDERAL PIN
OH000000120234OtherANTHEM TRADITIONAL PLAN
OH000000120234OtherANTHEM TRADITIONAL PLAN
OH1279940001Medicare NSC
OH$$$$$$$$$005OtherMEDICAL MUTUAL OF OHIO