Provider Demographics
NPI:1114963766
Name:CAMPBELL, VERN J (MD)
Entity Type:Individual
Prefix:DR
First Name:VERN
Middle Name:J
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:932 SPRING ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-2855
Mailing Address - Country:US
Mailing Address - Phone:231-487-5315
Mailing Address - Fax:
Practice Address - Street 1:932 SPRING ST
Practice Address - Street 2:SUITE 101
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-2855
Practice Address - Country:US
Practice Address - Phone:231-487-5315
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIVC059657207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4549885Medicaid
MI4549885Medicaid
MI0N78890Medicare PIN
MI5150030001Medicare NSC